Cardiac Masses on Cardiac CT: A Review

Kassop, David; Donovan, Michael; Cheezum, Michael K.; Nguyen, Binh; Gambill, Neil B.; Blankstein, Ron; Villines, Todd C.

doi:10.1007/s12410-014-9281-1

Cited by 191 publications

(182 citation statements)

References 37 publications

(45 reference statements)

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“…Certain characteristics identified on CT imaging may help distinguish neoplastic versus non-neoplastic masses and benign versus malignant tumors. 15) Sometimes, electrocardiography may help echocardiography and CT. 16) In our case, the CS mass was unlikely to be a vegetation because such patients usually have fevers, congenital heart disease, or a history of intravenous drug use. 17) A CS mass is unlikely to be a thrombus because such patients usually have a history of CS endothelial injury caused by right heart procedures or cardiac surgery.…”

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confidence: 99%

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Unusual Coronary Sinus Tumor in a Pregnant Woman

et al. 2017

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SummaryPrimary coronary sinus tumors are extremely rare. Herein, we present a case of a pregnant woman with a primary myxoma in the coronary sinus (CS), which was diagnosed by echocardiography and computed tomography. We reviewed the literature and found two other primary CS tumors. We summarized the gender, ages, symptoms, diagnostic methods, associated anomalies, treatments, histologic findings, and outcomes of the 3 cases. Dyspnea was a common symptom of all 3 patients. Diagnostic methods included echocardiography, computed tomography, magnetic resonance imaging, and coronary angiography. Associated anomalies included coronary artery fistulas, coronary sinus orifice atresia with persistent left superior vena cava, intra-cardiac invasion, and pericardial effusion. The 3 histologic types of primary CS tumor were haemangioma, lymphoma, and myxoma. The 3 patients received proper treatment and had good therapeutic outcomes. (Int Heart J 2017; 58: 633-636) Key words: Primary, Myxoma, Echocardiography, Computed tomography C ardiac tumors are an uncommon imaging diagnosis, and are comprised of primary cardiac and metastatic tumors. 1) Primary cardiac tumors are rare, with a reported prevalence of 0.001%-0.030% in an autopsy series, while metastatic tumors of the heart are reported to be 10-1000 times more common.2) Three-fourths of primary cardiac tumors are benign, and nearly one-half of benign heart tumors are cardiac myxomas (CMs). CMs can occur anywhere in the heart, but most commonly arise in the left atrium (60%-80%), followed by the right atrium (15%-28%), the right ventricle (8%), and the left ventricle (3%-4%).3,4) Herein, we present the case of a pregnant woman with a CM in the coronary sinus (CS). Case ReportA 32-year-old primigravida presented to the emergency room with sudden abdominal pain at 38-week gestation. She also had dyspnea without fever. On physical examination, her respiratory rate was 30/minute, pulse was 95/minute, blood pressure was 130/85 mmHg, and her temperature was 37.0°C. There were no murmurs on auscultation of the heart. The electrocardiogram showed a normal heart rhythm. Emergency echocardiographic ultrasound showed a dilated CS and pericardial effusion (PE) in the parasternal long axis view ( Figure 1A). The dilated CS was filled with low echo. The 4 chambers of the heart did not have any abnormalities. This mass measured 3.97 × 3.01 cm in the apical 4-chamber view ( Figure 1B). To rule out infective endocarditis, the white blood cell count, erythrocyte sedimentation rate, and C-reactive protein level were determined, which were all normal. To rule out a thrombus in the CS, parameters were determined, which were normal, including the D-dimer level (1.23 ug/mL). Therefore, there was a high likelihood that this mass was a tumor. Six hours later, she delivered a male infant with a birth weight of 3550 g by spontaneous vaginal delivery. To confirm the tumor type, contrast-enhanced chest computed tomography (CT) was performed 1 day later. Before contrast agent injection, it was reve...

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confidence: 99%

“…Contrast-enhanced chest CT helped identify the types of benign primary cardiac tumors. 14,15,19) Associated anomalies included coronary artery fistula, CS orifice atresia with persistent left superior vena cava, intracardiac invasion, and PE. There are no special anomalies associated with primary CS tumors, according to the literature.…”

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confidence: 99%

Unusual Coronary Sinus Tumor in a Pregnant Woman

et al. 2017

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“…The hypothesis that intracardiac ectopic thyroid is due to abnormal persistence of contact between the thyroid primordium and the bulbus cordis during embryogenesis is convincing, because the site of ectopic thyroid is almost in the right ventricular septal surface in those middle-age female patients. Certain characteristics identified on noninvasive imaging may help distinguish neoplastic versus non-neoplastic masses and benign versus malignant tumors [2]. Echocardiography remains the first line technique for cardiac mass evaluation because of its widespread availability and its dynamic assessment of cardiac masses in the relation to the surrounding chambers, valves, and pericardium.…”

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confidence: 99%

Right Ventricular Mass: Intracardiac Ectopic Thyroid

Lü¹,

Y²,

Liu³

et al. 2017

Intern Med

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A 53-year-old woman complained of intermittent angina pectoris for 2 years and was admitted to our hospital to further evaluate cardiac mass. Electrocardiograph(ECG) showed sinus rhythm with incomplete right bundle branch block. Because a primitive cardiac tumor was highly suspected, exploratory surgery was performed. Intraoperative inspection revealed a red mass with a broad base arising from the middle-upper part of the interventricular septum close to the septal leaflet of the tricuspid valve.Keywords: Intracardiac ectopic thyroid; Angiography; Malignant tumors; Thyroid scintigraphy Case ReportA 53-year-old woman complained of intermittent angina pectoris for 2 years and was admitted to our hospital to further evaluate cardiac mass. Physical examination was unremarkable. Results of routine laboratory tests including thyroid function (FT3 5.32 pmol/L, FT4 21.07 pmol/L, TSH 4.1 uIU/ml) were all normal. Chest plain film showed a normal size heart (Figure 1). Angiography was not performed because of the potential risk of peripheral embolization due to the dislodgement of tumor fragment or surface thrombosis. Because a primitive cardiac tumor was highly suspected, exploratory surgery was performed. Intraoperative inspection revealed a red mass with a broad base arising from the Internal Medicine: Open Access

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“…The evidence of a cardiac mass normally requires a complex differential diagnosis between benign tumors (myxoma, lipoma, papillary fibroelastoma, rhabdomyoma, fibroma, teratoma, Purkinje cells tumors/amarthomas, hemangioma), malignant tumors (angiosarcoma, rhabdomyosarcoma, fibrosarcoma, lymphosarcoma, osteosarcoma, liposarcoma), metastases, tumors that may be either benign or malignant (paraganglioma, mesothelioma) and non-neoplastic masses (intracardiac thrombus, endocarditis vegetation, lipomatous hypertrophy of interatrial septum, pericardial cyst, large coronary artery aneurism, crista terminalis) [6,7]. However, due to the clinical history and condition of the patient the possibility excluded was that the mass at the left side of the interventricular septum was a benign tumor.…”

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confidence: 99%

“…Because patient signs and symptoms are often absent or nonspecific, clinical suspicion is paramount and echocardiography is the first line imaging modality. Cardiac computed tomography may confirm the presence of intracardiac masses [6].…”

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confidence: 99%

Rare left ventricular metastasis from uveal melanoma

et al. 2017

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A 60-year-old white woman was admitted to our hospital, October 2016 because of two episodes of hematemesis in the previous 48 h, intensification of fatigue and lack of appetite. A review of the patient's history revealed that a stage IV right ocular melanoma had been diagnosed 7 years prior to admission. The patient underwent proton beam therapy and then first-line and second-line chemotherapy treatment. When the patient was admitted she was affected by multiple subcutaneous (Fig. 1A), pericardial (Fig. 1B, C), pulmonary and hepatic metastases. Subcutaneous metastases had been previously treated with electrochemotherapy. Blood analysis showed mild anemia (red blood cells 2.980.000 μL, hemoglobin 9.7 g/dL) and an increased inflammatory pattern (white blood cells 12540 μL procalcitonin 1.7 ng/mL, C reactive protein 10 mg/L) as observed in multiple metastasis [1]. Physical examination revealed pale skin color, increased liver consistency and volume; no other abnormalities were found, including cardiac auscultation. Electrocardiogram and hemogasanalysis were also normal. In order to rule out upper gastrointestinal bleeding, esophagogastroduodenoscopy was performed and showed no abnormalities. Given the suspicion of pulmonary embolism, due to advanced cancer and recurrent haemoptysis, we performed a trans-thoracic echocardiography that showed normal parameters (left ventricular diastolic and systolic diameter 44 mm and 29 mm, septal thickness 9 mm, posterior wall thickness 8 mm, ejection fraction 58%, left atrial area 14 cm 2 , right atrial area 12 cm 2 , right ventricular diastolic and systolic diameter 27 mm and 16 mm, TAPSE 18 mm) and there were no signs of right heart overload; unexpectedly, a pedunculated 15 × 13 × 14 mm mass was present, adherent to the endocardium, involving the lower third of both the interventricular septum and the left ventricle inferior wall (Fig. 1C, D). The mass was slightly hyperechoic and non-homogeneous with irregular margins (Fig. 1D). The color-Doppler did not show significant vascularization of the mass. No signs of patent foramen ovale were observed. The case was then discussed by a multidisciplinary team including oncologists and cardiac surgeons. Considering the evidence of multiple metastatic disease, the poor prognosis and thus the unfeasibility of any surgical and medical treatment of the patient, it was decided to stop any further diagnostic and/or therapeutical procedure and to continue palliative cure. The patient was then discharged 5 days after admission.Uveal melanoma is the most common primary intraocular malignancy; approximately 1500 cases are diagnosed in the United States each year, most commonly arising in the choroid followed by the ciliary body. The patient can be entirely asymptomatic and the tumour diagnosed only on routine ophthalmic screening [2]. The heart may be colonized by metastatic cells of uveal melanoma through the vascular system but often the diagnosis is missed over a lifetime [3]. It has been known since 1954 that the right side of the heart is ...

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Cardiac Masses on Cardiac CT: A Review

Cited by 191 publications

References 37 publications

Unusual Coronary Sinus Tumor in a Pregnant Woman

Unusual Coronary Sinus Tumor in a Pregnant Woman

Right Ventricular Mass: Intracardiac Ectopic Thyroid

Rare left ventricular metastasis from uveal melanoma

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