Abstract
Cardiac masses may present themselves upon investigation of cardiovascular symptoms, systemic manifestations, or incidentally upon screening. The differential diagnosis, workup, and subsequent management are heavily dependent upon the presenting clinical setting and the individual patient. In the broadest terms, a mass may be a benign or malignant tumor, a degenerative or infectious process, a normal but prominent structure, or even merely an imaging artifact that has been misinterpreted.
Armed with a basic knowledge of the most common entities and the demographic in which they typically present, together with an awareness of the pathways in which cancer or masses can involve the heart, one may then choose the most appropriate cardiac imaging modality and workup to diagnose and treat the patient.
In this chapter, the most common masses affecting the heart are presented with updated strategies for further refining the differential diagnosis. Initial treatment strategies and recommendations based on the available literature are presented.
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Myxoma apical four-chamber (see Fig. 25.2). Apical four-chamber view shows tethering of the myxoma to the interatrial septum and prolapse through the mitral valve into the left ventricle. This was associated with the characteristic tumor “plop” on auscultation (AVI 5673 kb)
Myxoma parasternal short axis (see Fig. 25.2). Parasternal short axis view shows tethering of the myxoma to the interatrial septum and prolapse through the mitral valve into the left ventricle. This was associated with the characteristic tumor “plop” on auscultation (AVI 6031 kb)
Papillary fibroelastoma (see Fig. 25.3). This 48-year old female presented with palpitations. Stress echocardiography incidentally revealed a 1.1 cm mobile mass on the aortic aspect of the right coronary cusp. Although otherwise asymptomatic, resection was advised due to embolic risk. She underwent a minimally invasive surgery in which the tumor and its thin stalk was resected, with no further valve repair required (AVI 2669 kb)
Lipoma and tamponade (see Fig. 25.4). Patient developed complications from bother lung cancer including partial superior vena cava (SVC) syndrome and pericardial tamponade, requiring pericardiocentesis and, ultimately, a pericardial window for palliation (AVI 7972 kb)
Renal cell cancer RA inflow (see Fig. 25.5). Thrombus and renal cell cancer. Apical four-chamber echocardiographic view of a mobile mass in the right atrium which is not anchored to the interatrial septum and is seen in right atrial inflow views (AVI 3911 kb)
Caseous mitral annular calcification (see Fig. 25.6). TEE apical five-chamber view zoomed in on a spherical 3.5 cm heterogeneously echogenic mass which appears within the mitral annulus and protrudes into the left ventricular cavity, in an 80-year old female presenting with fever and retinal artery occlusion. Note the acoustic shadowing (black ray cast by calcification on the atrial surface of the mass, which prevents the ultrasound beams from passing through and obscures a narrow wedge of the left ventricle) (AVI 5965 kb)
A discrete mobile mass was noted near the apical portion within the left ventricular cavity, associated with the mitral subvalvular apparatus. Apical two-chamber echo view, in which intravenous echo contrast demonstrates that the mass is not vascular (is not perfused by contrast) (AVI 5308 kb)
Cardiac MRI of the same mass as in Video 25.6a demonstrating it to be a bilobed papillary muscle (WMV 169 kb)
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Wu, J.C. (2014). Cardiac Tumors and Masses. In: Stergiopoulos, K., Brown, D. (eds) Evidence-Based Cardiology Consult. Springer, London. https://doi.org/10.1007/978-1-4471-4441-0_25
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DOI: https://doi.org/10.1007/978-1-4471-4441-0_25
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