Skip to main content

Cardiac Tumors: Clinical Presentation, Diagnosis, and Management

Opinion statement

Cardiac masses and tumors are a heterogenous group of disorders and include primary tumors (both benign and malignant), metastatic disease, and numerous masquerades such as thrombus. Clinical presentation ranges from incidental discovery on imaging tests ordered for other reasons to life-threatening presentations such as cardiac tamponade, arrhythmia, obstruction, and systemic embolization. Of the available imaging modalities, cardiac MRI is generally the most useful for assessment and helps to delineate the relevant anatomy. Due to the technical difficulties and risk of biopsy of cardiac masses, a presumptive diagnosis is typically made using imaging techniques with surgery serving both a diagnostic and curative role. Because these conditions can vary widely in their management, we recommend early involvement of a multidisciplinary group which should include a cardiologist, cardiac surgeon, and oncologist.

This is a preview of subscription content, access via your institution.

Fig. 1

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Al-Mamgani A, Baartman L, Baaijens M, et al. Cardiac metastases. Int J Clin Oncol. 2008;13:369–72.

    PubMed  Article  Google Scholar 

  2. Klatt EC, Heitz DR. Cardiac metastases. Cancer. 1990;65:1456–9.

    CAS  PubMed  Article  Google Scholar 

  3. Primary tumors of the heart. In Bonow RO, Mann DL, Zipes DP, Libby P (eds): Braunwald’s heart disease. 9th ed. Philadelphia, Elsevier Saunders, 2011, pp 1638–1650.

  4. Cardiac tumors. In Crawford MH, DiMarco JP and Paulus WJ (eds): Cardiology. 3rd ed. Philadelphia, Elsevier Saunders, 2010, pp 1743–1751.

  5. Stollberger C, Chnupa P, Kronik G, Brainin M, Finsterer J, Schneider B, et al. Transesophageal echocardiography to assess embolic risk in patients with atrial fibrillation. ELAT Study Group. Embolism in left atrial thrombi. Ann Intern Med. 1998;128:630–8.

    CAS  PubMed  Article  Google Scholar 

  6. Sharma ND, McCullough PA, Philbin EF, Weaver WD. Left ventricular thrombus and subsequent thromboembolism in patients with severe systolic dysfunction. Chest. 2000;117:314–20.

    CAS  PubMed  Article  Google Scholar 

  7. Gertner E, Leatherman JW. Intracardiac mural thrombus mimicking atrial myxoma in the antiphospholipid syndrome. J Rheumatol. 1992;19:1293–8.

    CAS  PubMed  Google Scholar 

  8. Kirkpatrick JN, Wong T, Bednarz JE, Spencer KT, Sugeng L, Ward RP, et al. Differential diagnosis of cardiac masses using contrast echocardiographic perfusion imaging. J Am Coll Cardiol. 2004;43:1412–9.

    PubMed  Article  Google Scholar 

  9. Kassop D, Donovan MS, Cheezum MK, Nguyen BT, Gambill NB, Blankstein R, et al. Cardiac masses on cardiac CT: a review. Curr Cardiovasc Imaging Rep. 2014;7:9281.

    PubMed  PubMed Central  Article  Google Scholar 

  10. • Giusca S, Mereles D, Ochs A, Buss S, Andre F, Seitz S, et al. Incremental value of cardiac magnetic resonance for the evaluation of cardiac tumors in adults: experience of a high volume tertiary cardiology centre. Int J Card Imaging. 2017;33:879–88 This is a retrospective analysis of a large number of cardiac masses evaluated by cardiac MRI and shows superior mass identification as compared with echocardiography.

    Article  Google Scholar 

  11. Nazarian S, Hansford R, Rahsepar AA, Weltin V, McVeigh D, Gucuk Ipek E, et al. Safety of magnetic resonance imaging in patients with cardiac devices. N Engl J Med. 2017;377:2555–64.

    PubMed  PubMed Central  Article  Google Scholar 

  12. Pazos-Lopez P, Pozo E, Siqueira ME, Garcia-Lunar I, Cham M, Jacobi A, et al. Value of CMR for the differential diagnosis of cardiac masses. JACC Cardiovasc Imaging. 2014;7:896–905.

    PubMed  Article  Google Scholar 

  13. Chan AT, Plodkowski AJ, Pun SC, Lakhman Y, Halpenny DF, Kim J, et al. Prognostic utility of differential tissue characterization of cardiac neoplasm and thrombus via late gadolinium enhancement cardiovascular magnetic resonance among patients with advanced systemic cancer. J Cardiovasc Magn Reson. 2017;19:76.

    PubMed  PubMed Central  Article  Google Scholar 

  14. Ganame J, Wright J, Bogaert J. Cardiac lipoma diagnosed by cardiac magnetic resonance imaging. Eur Heart J. 2008;29:697.

    PubMed  Article  Google Scholar 

  15. Rahbar K, Seifarth H, Schafers M, Stegger L, Hoffmeier A, Spieker T, et al. Differentiation of malignant and benign cardiac tumors using 18F-FDG PET/CT. J Nucl Med. 2012;53:856–63.

    CAS  PubMed  Article  Google Scholar 

  16. Chan ATF, J. Perez Johnston, R. Plodkowski, A. Pollie, M. Moskowitz, C. Steingart, R. Weinsaft, J.W. Biologic and prognostic validation of delayed enhancement (DE-) CMR for cancer-associated cardiac masses - multimodality comparison to positron emission tomography (PET) [ABSTRACT]. Society for Cardiovascular Magnetic Resonance Scientific Sessions. 2018:22.

  17. Klein MA, Scalcione LR, Youn T, Shah RA, Katz DS, Sung WW, et al. Intensely hypermetabolic lipomatous hypertrophy of the interatrial septum on 18-FDG PET with MRI and CT correlation. Clin Nucl Med. 2010;35:972–3.

    PubMed  Article  Google Scholar 

  18. Nensa F, Tezgah E, Poeppel TD, Jensen CJ, Schelhorn J, Kohler J, et al. Integrated 18F-FDG PET/MR imaging in the assessment of cardiac masses: a pilot study. J Nucl Med. 2015;56:255–60.

    PubMed  Article  Google Scholar 

  19. Theologides A. Neoplastic cardiac tamponade. Semin Oncol. 1978;5:181–92.

    CAS  PubMed  Google Scholar 

  20. Lee AY, Levine MN, Baker RI, Bowden C, Kakkar AK, Prins M, et al. Randomized comparison of low-molecular-weight heparin versus oral anticoagulant therapy for the prevention of recurrent venous thromboembolism in patients with cancer I. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med. 2003;349:146–53.

    CAS  PubMed  Article  Google Scholar 

  21. Raskob GE, van Es N, Verhamme P, Carrier M, Di Nisio M, Garcia D, et al. Edoxaban for the treatment of cancer-associated venous thromboembolism. N Engl J Med. 2018;378:615–24.

    CAS  PubMed  Article  Google Scholar 

  22. Srichai MB, Junor C, Rodriguez LL, Stillman AE, Grimm RA, Lieber ML, Weaver JA, Smedira NG and White RD. Clinical, imaging, and pathological characteristics of left ventricular thrombus: a comparison of contrast-enhanced magnetic resonance imaging, transthoracic echocardiography, and transesophageal echocardiography with surgical or pathological validation. Am Heart J. 2006;152:75-84.

    PubMed  Article  Google Scholar 

  23. Hong YJ, Hur J, Kim YJ, Lee HJ, Nam JE, Kim HY, Choe KO and Choi BW. The usefulness of delayed contrast-enhanced cardiovascular magnetic resonance imaging in differentiating cardiac tumors from thrombi in stroke patients. Int J Cardiovasc Imaging. 2011;27 Suppl 1:89-95.

    PubMed  Article  Google Scholar 

  24. Weinsaft JW, Kim HW, Crowley AL, Klem I, Shenoy C, Van Assche L, Brosnan R, Shah DJ, Velazquez EJ, Parker M, Judd RM and Kim RJ. LV thrombus detection by routine echocardiography: insights into performance characteristics using delayed enhancement CMR. JACC Cardiovasc Imaging. 2011;4:702-12.

    PubMed  Google Scholar 

  25. Chen-Milhone CS, Chakravarthy Potu K, Mungee S. Cardiac aspergilloma: a rare case of a cardiac mass involving the native tricuspid valve, right atrium, and right ventricle in an immunocompromised patient. Case Rep Cardiol. 2018;2018:6927436.

    Article  Google Scholar 

  26. Biller J, Challa VR, Toole JF, Howard VJ. Nonbacterial thrombotic endocarditis. A neurologic perspective of clinicopathologic correlations of 99 patients. Arch Neurol. 1982;39:95–8.

    CAS  PubMed  Article  Google Scholar 

  27. Tower-Rader A, Kwon D. Pericardial masses, cysts and diverticula: a comprehensive review using multimodality imaging. Prog Cardiovasc Dis. 2017;59:389–97.

    PubMed  Article  Google Scholar 

  28. Yared K, Baggish AL, Picard MH, Hoffmann U, Hung J. Multimodality imaging of pericardial diseases. JACC Cardiovasc Imaging. 2010;3:650–60.

    PubMed  Google Scholar 

  29. Frank H, Globits S. Magnetic resonance imaging evaluation of myocardial and pericardial disease. J Magn Reson Imaging. 1999;10:617–26.

    CAS  PubMed  Article  Google Scholar 

  30. Heyer CM, Kagel T, Lemburg SP, Bauer TT, Nicolas V. Lipomatous hypertrophy of the interatrial septum: a prospective study of incidence, imaging findings, and clinical symptoms. Chest. 2003;124:2068–73.

    PubMed  Article  Google Scholar 

  31. Reynen K. Frequency of primary tumors of the heart. Am J Cardiol. 1996;77:107.

    CAS  PubMed  Article  Google Scholar 

  32. Centofanti P, Di Rosa E, Deorsola L, et al. Primary cardiac neoplasms: early and late results of surgical treatment in 91 patients. Ann Thorac Surg. 1999;68:1236–41.

  33. Sarjeant JM, Butany J, Cusimano RJ. Cancer of the heart: epidemiology and management of primary neoplasms and metastases. Am J Cardiovasc Drugs. 2003;3:407–21.

    PubMed  Article  Google Scholar 

  34. Pinede L, Duhaut P, Loire R. Clinical presentation of left atrial cardiac myxoma: a series of 112 consecutive cases. Medicine. 2001;80:159–72.

    CAS  PubMed  Article  Google Scholar 

  35. McAllister H, Fenoglio J. Tumors of the cardiovascular system. In: Hartmannn W, Cowan W, editors. Atlas of tumor pathology. Washington, DC: Armed Forces Institute of Pathology; 1978. p. 1–20.

  36. Reynen K. Cardiac myxomas. N Engl J Med. 1995;333:1610–7.

    CAS  PubMed  Article  Google Scholar 

  37. Carney J, Gordon H, Carpenter P, Shenoy B, Go V. The complex of myxomas, spotty pigmentation, and endocrine overactivity. Medicine. 1985;64(4):270–83.

    CAS  PubMed  Article  Google Scholar 

  38. McCarthy PM, Piehler JM, Schaff HV, Pluth JR, Orszulak TA, Vidaillet HJ Jr, et al. The significance of multiple, recurrent, and “complex” cardiac myxomas. J Thorac Cardiovasc Surg. 1986;91:389–96.

  39. Waller DA, Ettles DF, Saunders NR, Williams G. Recurrent cardiac myxoma: the surgical implications of two distinct groups of patients. Thorac Cardiovasc Surg. 1989;37:226–30.

    CAS  PubMed  Article  Google Scholar 

  40. Mariscalco G, Bruno VD, Borsani P, Dominici C, Sala A. Papillary fibroelastoma: insight to a primary cardiac valve tumor. J Card Surg. 2010;25:198–205.

    PubMed  Article  Google Scholar 

  41. Yee HC, Nwosu JE, Lii AD, Velasco M, Millman A. Echocardiographic features of papillary fibroelastoma and their consequences and management. Am J Cardiol. 1997;80:811–4.

    CAS  PubMed  Article  Google Scholar 

  42. Jain D, Maleszewski JJ, Halushka MK. Benign cardiac tumors and tumorlike conditions. Ann Diagn Pathol. 2010;14:215–30.

    PubMed  Article  Google Scholar 

  43. Freedom RM, Lee KJ, MacDonald C, Taylor G. Selected aspects of cardiac tumors in infancy and childhood. Pediatr Cardiol. 2000;21:299–316.

    CAS  PubMed  Article  Google Scholar 

  44. Uzun O, Wilson DG, Vulanic GM, et al. Cardiac tumours in children. Orphanet J Rare Dis. 2007;2:11.

  45. Gunther T, Schreiber C, Noebauer C, Eicken A, Lange R. Treatment strategies for pediatric patients with primary cardiac and pericardial tumors: a 30-year review. Pediatr Cardiol. 2008;29:1071–6.

    PubMed  Article  Google Scholar 

  46. Chen TW, Loong HH, Srikanthan A, et al. Primary cardiac sarcomas: a multinational retrospective review. Cancer Med 2018; 1–7.

  47. Ramlawi B, Leja MJ, Abu Saleh WK, al Jabbari O, Benjamin R, Ravi V, et al. Surgical treatment of primary cardiac sarcomas: review of a single-institution experience. Ann Thorac Surg. 2016;101:698–702.

    PubMed  Article  Google Scholar 

  48. Hamidi M, Moody JS, Weigel TL, Kozak KR. Primary cardiac sarcoma. Ann Thorac Surg. 2010;90:176–81.

    PubMed  PubMed Central  Article  Google Scholar 

  49. Isambert N, Ray-Coquard I, Italiano A, Rios M, Kerbrat P, Gauthier M, et al. Primary cardiac sarcomas: a retrospective study of the French Sarcoma Group. Eur J Cancer. 2014;50(1):128–36.

    PubMed  Article  Google Scholar 

  50. • Randhawa JS, Budd GT, Randhawa M, Ahluwalia M, Jia X, Daw H, et al. Primary cardiac sarcoma: 25-year Cleveland Clinic experience. Am J Clin Oncol. 2016;39(6):593–99. This is a retrospective review of 42 cases of primary cardiac sarcoma and described a benefit in patients who received multimodality therapy.

    PubMed  Article  Google Scholar 

  51. Reardon MJ, DeFelice CA, Sheinbaum R, Baldwin J. Cardiac autotransplant for surgical treatment of a malignant neoplasm. Ann Thorac Surg. 1999;67:1793–5.

    CAS  PubMed  Article  Google Scholar 

  52. •• Abu Saleh WK, Ramlawi B, Shapira OM, et al. Improved outcomes with the evolution of neoadjuvant chemotherapy approach to right heart sarcoma. Ann Thorac Surg. 2017;104(1):90–6. This is a single-center study of 133 primary cardiac sarcoma cases with a focus on the management of right-sided sarcomas. This study demonstrated a marked survival benefit with complete resection, leading to a recommendation for neoadjuvant therapy to increase the probability of achieving complete resection.

    PubMed  Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Gregg F. Rosner MD.

Ethics declarations

Conflict of Interest

Timothy J. Poterucha owns a stock in Abbott Laboratories and AbbVie, Inc.

Jonathan Kochav declares that he has no conflict of interest.

Daniel S. O’Connor declares that he has no conflict of interest.

Gregg F. Rosner declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Cardio-oncology

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Poterucha, T.J., Kochav, J., O’Connor, D.S. et al. Cardiac Tumors: Clinical Presentation, Diagnosis, and Management. Curr. Treat. Options in Oncol. 20, 66 (2019). https://doi.org/10.1007/s11864-019-0662-1

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11864-019-0662-1

Keywords

  • Cardiac mass
  • Cardiac tumor
  • Myxoma
  • Rhabdomyoma
  • Rhabdomyosarcoma