Characterization of Cardiac Sarcoma With 2- and 3-Dimensional Echocardiography, Myocardial Contrast Echocardiography and Cardiac Magnetic Resonance Imaging

Abstract

A 57-year-old woman had previously undergone a right hemicolectomy for Duke B adenocarcinoma of caecum. She presented with acute back pain. A magnetic resonance imaging scan of her thoracic spine showed destruction of a vertebra with a tumor deposit at T11 ( Figure 1A). She underwent a course of radiotherapy (20 Gray in 5 fractions) to this area. Good symptomatic relief was obtained. Biopsy demonstrated a sarcomatoid tumor suggestive of leiomyosarcoma. Over the next 2 months she developed dyspnea on exertion, fatigue, and leg edema. Examination revealed a Figure 1. A, Magnetic resonance image (MRI) of thoracic spine identified destruction of a T11 vertebral body with metastatic replacement and impingement of spinal cord. B, Three-dimensional (3D) transthoracic echocardiogram (TEE) demonstrating the mass originating from the superior vena cava extending to the right atrium and prolapsing through the tricuspid valve into the right ventricle (RV). LV indicates left ventricle; LA, left atrium. C, 3D TTE. The mass was seen to obstruct the right ventricular inflow, almost completely occluding the tricuspid valve annulus during diastole. D, Myocardial contrast echocardiogram (MCE). To assess the vascularity of the mass, the patient underwent MCE. Limited passage of microbubbles into mass (arrow; partial enhancement) suggests tumor of low vascularity.

From Pulmonary Artery Repair to Right Ventricular Outflow Tract Replacement

“…Use of TEE played a prominent role in establishing a PAS diagnosis in 2 other cases. 11,12 However, in these instances, TEE was used in the preoperative setting. Compared to other imaging modalities, TEE allows for the real-time characterization of the physiologic details of a lesion while simultaneously assessing ventricular and valvular function.…”

Primary cardiac angiosarcoma. Histopathology imaging correlation

“…PCA has a tendency to occur in the third to fifth decade and is more common in males. Although dyspnea is the most common symptom, symptoms vary according to site and size of tumor, myocardial involvement, and development of pericardial effusion [1][2][3]. The right atrium was reported to be the most affected site by PCA with invasion of the lateral (free) wall of the right atrium while the septum remains spared in most cases [1][2][3].…”

“…Although dyspnea is the most common symptom, symptoms vary according to site and size of tumor, myocardial involvement, and development of pericardial effusion [1][2][3]. The right atrium was reported to be the most affected site by PCA with invasion of the lateral (free) wall of the right atrium while the septum remains spared in most cases [1][2][3]. The differential diagnosis of a right atrial mass includes benign entities such as myxoma and thrombus versus malignant pathologies such as metastatic involvement of the heart, PCA, and primary cardiac lymphoma [2].…”

“…When MRI is not readily available or contraindicated, CT can be a valid alternative for assessing PCA, which usually appears as an irregular lobulated lowattenuated mass [1]. Tumor vascularity seen on coronary angiography can help differentiate homogenous vascular hemangioma from PCA, the latter being characterized by new vessel formation to feed the tumor (tumor blush), usually arising from right coronary artery [2,3]. Although PCA is believed to originate de novo, interestingly, few cases in the literature suggested that PCA can arise from benign lesions including hemangioma.…”

“…Differential diagnosis of a right atrial mass includes benign entities such as myxoma and thrombus versus malignant pathologies such as metastatic involvement of the heart, PCA, and primary cardiac lymphoma [2]. Cardiac tumor evaluation should combine imaging modalities that enable comprehensive evaluation of both anatomical as well as functional properties of the tumors [1][2][3].…”