Differential diagnosis of cardiac masses using contrast echocardiographic perfusion imaging

Kirkpatrick, James N.; Wong, Tiffany; Bednarz, J.; Spencer, Kirk T.; Sugeng, Lissa; Ward, R. Parker; DeCara, Jeanne M.; Weinert, Lynn; Krausz, T.; Lang, Roberto M.

doi:10.1016/j.jacc.2003.09.065

Cited by 251 publications

(98 citation statements)

References 31 publications

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“…Beyond anatomic imaging, CMR enables tissue characterization of cardiac masses based on vascular supply. Differentiation of neoplasm from thrombus based on contrast uptake has been validated in relation to histopathology findings 7, 8, 9. Tissue characterization imaging of masses has also been shown to stratify clinical outcomes 4.…”

Section: Introductionmentioning

confidence: 99%

Pattern and Prognostic Implications of Cardiac Metastases Among Patients With Advanced Systemic Cancer Assessed With Cardiac Magnetic Resonance Imaging

Pun

Plodkowski

Matasar

et al. 2016

JAHA

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BackgroundCardiac magnetic resonance (CMR) imaging is well validated for tissue characterization of cardiac masses but has not been applied to study pattern and prognostic implications of cardiac metastases (CMETs) among patients with systemic cancer.Methods and ResultsThe population consisted of 60 patients with stage IV cancer (32 patients with CMETs, 28 diagnosis‐matched controls) undergoing CMR. CMET was defined as a discrete mass with vascular tissue properties on delayed enhancement CMR. CMET‐positive patients and controls had similar clinical characteristics, cardiac geometry, and function (P=NS). Leading cancer types associated with CMET were sarcoma, melanoma, and gastrointestinal. Patients with CMETs had similar distribution of extracardiac metastatic disease compared with controls (organs involved: 3.4±2.0 versus 2.7±1.9, P=0.17). In 94% of patients with CMETs, there were metastases involving ≥1 extracardiac organ (66% lung involvement). CMET location varied (right ventricle 44%, right atrium 19%, left ventricle 28%, left atrium 9%, pericardial 25%); 22% of cases had multichamber involvement. Right‐sided chamber involvement was common in hematologic/lymphatic spread (67%); pericardial involvement was common with direct spread (64%). Regarding tissue properties on delayed enhancement CMR, CMETs commonly (59%) demonstrated heterogeneous enhancement (41% diffuse enhancement). Heterogeneous lesions were larger and had increased border irregularity (P<0.05). Survival 6 months post‐CMR was numerically lower among patients with CMETs (56% [95% CI 39–74%]) versus stage IV cancer–matched controls (68% [95% CI 50–86%]), although differences between groups were nonsignificant (P=0.42).Conclusions CMETs vary regarding etiology, location, and tissue properties on CMR, highlighting need for comprehensive surveillance of cardiac involvement regardless of cancer origin. Prognosis remains poor with for patients with CMETs, albeit similar to that for stage IV cancer controls matched for cancer etiology.

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Section: Introductionmentioning

confidence: 99%

Pattern and Prognostic Implications of Cardiac Metastases Among Patients With Advanced Systemic Cancer Assessed With Cardiac Magnetic Resonance Imaging

Pun

Plodkowski

Matasar

et al. 2016

JAHA

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“…Kirkpatrick et al have suggested that malignancy causes hyperenhancement in contrast echo due to its rich vascularisation. On the other hand, a complete lack of enhancement suggests the presence of thrombus 20. Cardiac MRI has been also recently extensively studied for the use for differentiating cardiac masses.…”

Section: Discussionmentioning

confidence: 99%

Squamous cell carcinoma of unknown origin metastasising to the right atrium causing acute heart failure

Sladden¹,

Yamagata

Pllaha

et al. 2015

BMJ Case Reports

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We describe a case of metastasis to the heart, which was initially suspected to be a myxoma, causing acute right heart failure. Emergency surgery was carried out by opening the right atrium and superior vena cava, and debulking the tumour in a piecemeal fashion, providing temporary relief of symptoms. The histology showed this to be metastatic squamous cell carcinoma possibly of head and neck origin. This is extremely rare, with few published cases. Full endoscopic and CT, including positron emission tomography CT, investigation of the head and neck was performed with no primary findings. Only two such cases of squamous cell carcinoma of unknown origin metastasising to the heart have been described, and, in both cases, the patients died within several weeks of diagnosis. This patient remains alive 2 months postoperatively and is receiving radiotherapy to the chest, but his prognosis remains poor.

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“…This tumour could also be a thrombus, especially in the context of neoplasia. However, the tissue aspect of this tumour, the mass linked to the septal ventricular side of the tricuspid valve and the absence of associated pulmonary embolism rather suggested metastasis 2 3…”

Section: Answer: Cmentioning

confidence: 96%

An atypical intracardiac mass in a 61-year-old man

García

Ancédy

Delannoy

et al. 2014

Heart

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Differential diagnosis of cardiac masses using contrast echocardiographic perfusion imaging

Abstract: Echocardiographic contrast perfusion imaging aids in the differentiation of cardiac masses. Compared with the adjacent myocardium, malignant and vascular tumors hyper-enhanced, whereas stromal tumors and thrombi hypo-enhanced.

Cited by 251 publications

References 31 publications

Pattern and Prognostic Implications of Cardiac Metastases Among Patients With Advanced Systemic Cancer Assessed With Cardiac Magnetic Resonance Imaging

Pattern and Prognostic Implications of Cardiac Metastases Among Patients With Advanced Systemic Cancer Assessed With Cardiac Magnetic Resonance Imaging

Squamous cell carcinoma of unknown origin metastasising to the right atrium causing acute heart failure

An atypical intracardiac mass in a 61-year-old man

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