Cardiac Masses and Tumors

Transcription

1 Cardiac Masses and Tumors

2 Question: What is the diagnosis? A. Aortic valve myxoma B. Papillary fibroelastoma C. Vegetation from Infective endocarditis D. Thrombus in transit E. None of the above

3 Answer: What is the diagnosis? B A. Aortic valve myxoma B. Papillary fibroelastoma C. Vegetation from Infective endocarditis D. Thrombus in transit E. None of the above

4 Papillary fibroelastoma An incidental nodular mass (arrow) is seen attached to the commissure between the left and right coronary cusps. The mass has low attenuation, suggesting low vascularity. The appearance and location are typical of a papillary fibroelastoma. Papillary fibroelastomas are benign tumors that are attached to valves, chordae tendineae, papillary muscles, or the left or right ventricular endocardium.

5 Papillary fibroelastoma These tumors have the potential to embolize and are difficult to detect by CT because of their small size and high mobility. Resection is recommended in left sided fibroelastomas because the risk of embolic events may be as high as 25% in patients with previous transient ischemic attack or cerebrovascular accident symptoms and 6% in asymptomatic patients Gilkeson, Am J Roentgenol, 2006

6 Characteristic of common BENIGN primary tumors by CT

7 Characteristic of common BENIGN primary tumors by CT

8 Characteristic of common BENIGN primary tumors by CT

9 Characteristic of common BENIGN primary tumors by CT

10 Characteristic of common BENIGN primary tumors by CT

11 Characteristic of MALIGNANT primary tumors by CT

12 Characteristic of MALIGNANT primary tumors by CT

13 Intramyocardial lipoma The low attenuation value (- 116 HU) is consistent with fat. These tumors are rare and have no age or gender predisposition. Most are incidentally found in the interatrial septum or in the sub endocardium or sub pericardium of the free atrial or ventricular walls. Approximately 25% of these tumors are intramuscular Intramyocardial lipoma (arrow) found in a patient with atypical chest pain undergoing CT coronary angiography.

14 Pericardial Lipoma

15 Cardiac fibroma CT image shows a well-defined calcified center (arrow). A small circumferential effusion also is observed. Images obtained in a two-chamber projection from a patient presenting for evaluation of pleuritic chest pain. The findings are consistent with a fibroma The patient underwent successful resection of the mass. Fibromas are benign tumors that appear more frequently in children and adolescents. They often require resection because of their continuous growth and potential penetration into the pericardium, causing hemorrhagic pericarditis and tamponade.

16 Cardiac myxoma Cardiac myxomas are the most common cardiac tumors. They originate from primitive mesenchymal cells that may differentiate into several cell types, including endothelial and lipidic cells. The tumor is benign but it may cause serious sequelae because of the high rate of embolization Patient referred for evaluation of dyspnea. There is evidence of right ventricle dilatation and hypertrophy, with prominent trabeculations, suggesting pulmonary hypertension. A round mass (arrow) is observed in the right atrium, near the interatrial septum. Surgical pathology was consistent with a myxoma.

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19 Paraganglioma Biopsy was consistent with a paraganglioma. Only a few paragangliomas are intrathoracic, mostly located in the posterior mediastinum. Paragangliomas originate from sympathetic fibers or from ectopic chromaffin cells and may secrete catecholamines. Tissue histology revealed myxomatous tissue and thrombus. Image obtained from a patient presenting for evaluation of dyspnea, palpitations, and dysphagia. A large mass (arrow)with relatively smooth borders is seen in the posterior mediastinum, compressing or involving the posterior left atrial wall and compressing the ostia of the pulmonary veins.

20 Soft tissue sarcoma Biopsy was consistent with poorly differentiated soft tissue sarcoma. Sarcomas derive from mesenchymal cells and may adopt several morphologic types, including angiosarcoma, rhabdomyosarcoma, fibrosarcoma, liposarcoma, malignant fibrous histiocytoma, myxoid sarcoma, chondrosarcoma, or osteosarcoma. Image obtained from a patient presenting for evaluation of progressive dyspnea. There is evidence of multiple masses involving the atria, the interatrial septum, pericardium, and pleura (arrows). The masses have similar attenuation, except for lower attenuation in the inner core of the larger ones, suggesting hypoperfusion/necrosis.

21 Soft tissue sarcoma Biopsy was consistent with poorly differentiated soft tissue sarcoma. Sarcomas tend to exhibit rapid growth and are almost universally fatal unless they are detected when small and are fully resected. Cardiac transplantation is ineffective. It is believed that the use of immunosuppressants accelerates the growth of these tumors Image obtained from a patient presenting for evaluation of progressive dyspnea.

22 Angiosarcoma Histologic diagnosis was consistent with angiosarcoma. This tumor is more frequent in women, originates more commonly in the right atrium and may have intracavitary, polypoid, or diffusely infiltrative appearance. Symptoms vary according to anatomic location. Obstruction of the superior and inferior vena cava and invasion of the pericardium are common. Most are fatal within 4 to 24 months, regardless of treatment. Image obtained from a patient presenting with dyspnea and chest pain. CT demonstrates multiple large masses (arrows) with attenuation similar to that of the left ventricular myocardium, because of the rich vascularity and, therefore, contrast enhancement.

23 Pericardial mesothelioma Biopsy demonstrated a pericardial mesothelioma. Malignant mesotheliomas of the pericardium are very rare and, unlike pleural mesotheliomas, they do not appear to be related to previous asbestos exposure. These tumors are very aggressive and almost always fatal. Axial image obtained from a patient evaluated for dyspnea and chest pain. There are multiple masses (arrows) involving the pericardium, right atrium, right ventricle, and the pleural space.

24 Miscellaneous Cardiac Masses

25 Fibrosing mediastinitis Image obtained from a patient presenting for evaluation of dyspnea. After a right arm injection, there is string-like accumulation of contrast in mediastinal and azygous veins with lack of visualization of the superior vena cava (arrow). The obstruction of the superior vena cava is caused by fibrosing mediastinitis. This condition is an uncommon late immune-mediated complication related to previous infection from histoplasmosis or tuberculosis. Idiopathic mediastinal fibrosis also may occur in association with retroperitoneal fibrosis. The fibrotic changes predominantly involve the upper mediastinum and hilar regions. Symptoms are related to obstruction of the superior vena cava and less frequently the central pulmonary arteries and veins.

26 Fibrosing mediastinitis The obstruction of the superior vena cava is caused by fibrosing mediastinitis. Coronal maximum-intensity projection image obtained from panel A showing contrast opacification in the right subclavian, neck collaterals, and azygous veins (arrow). The superior vena cava is not opacified.

27 Hepatic cyst There is external compression of the right atrium and right ventricle by a giant hepatic cyst (arrows). External compression of the heart by intraabdominal or intrathoracic structures may resemble the signs and symptoms of constrictive pericardial disease.. Axial image obtained from a patient presenting with ascites and edema.

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46 Question: What is the diagnosis? A. Aortic valve myxoma B. Papillary fibroelastoma C. Vegetation from Infective endocarditis D. Thrombus in transit E. None of the above