Live Three‐Dimensional Transthoracic Echocardiographic Assessment of Left Atrial Tumors

Abstract

This preliminary study demonstrates the superiority of live three-dimensional transthoracic echocardiography (3D TTE) over two-dimensional (2D) TTE in the assessment of left atrial (LA) tumors in four patients studied by us (three myxomas, one hemangioma, all subsequently pathologically proven). Because of the unique ability of live 3D TTE to systematically section and view the contents of an intracardiac mass, LA myxomas in the three patients studied could be more confidently diagnosed by noting isolated echolucent areas consistent with hemorrhage/necrosis in the tumor mass. On the other hand, a definite echolucent area was found by 2D TTE in only two of the three patients with myxoma. In the fourth patient with a hemangioma, live 3D TTE showed much more extensive and closely packed echolucencies with little solid tissue as compared to a myxoma consistent with a highly vascularized tumor. In contrast, 2D TTE demonstrated only two isolated echolucencies in the tumor suggesting an erroneous diagnosis of myxoma.

Pathology, imaging, and treatment of cardiac tumours

“…Cardiac myxomas are usually attached by a stalk to the atrial septum in the fossa ovalis, and their range of movement is dependent on stalk length, tumour size, and morpho logy. Cardiac myxomas will enhance with use of echocardiography contrast 13,[17][18][19][20] . Differential diagnosis at imaging includes other tumour types, such as papillary fibroelastomas, blood cysts, sarcomas, fibromas, rhabdo myomas, thrombi, and metastases.…”

Cardiac tumors and sources of embolism

“…Myxomas captured in 3D datasets can be sliced tomographically to identify structural patterns, including cysts, necrosis, hemorrhage, or calcification, which can be characteristically found inside myxomas. Mehmood et al [36] described that isolated echolucent areas consistent with hemorrhage/necrosis in the tumor mass point towards myxoma in contrast to closely packed echolucencies which are more likely to be found in hemangioma. While in histological specimen myxomas are usually well vascularized, blood flow within the tumor is difficult to prove by echocardiography.…”

“…Although initial reports demonstrated RT3D TTE to be useful in the identification of myxoma [36], a recent report of RT3D TEE assessment has shown superior visualization of tumor characteristics and identification of spatial relationships [35], which can be important when planning the surgical procedure [38|.…”

“…They vary in size between less than 1 cm and more than 8 cm and are pedunculated, noncalcified but hyperdense [42]. Recent reports have shown the additive value of RT3DE in the detection and characterization of hemangioma, for example, RT3DE detects more extensive and closely packed echolucencies [36] and an intensive vascularization compared to myxoma [37].…”

Evaluation of intracardiac masses using three-dimensional echocardiography

“…In a preliminary study, Mehmood et al [8] demonstrated the superiority of live 3D over 2D transthoracic echocardiography (2D-TTE) in the assessment of left atrial (LA) tumors in patients with myxomas and hemangiomas. Because of the unique ability of live RT3DE to systematically section and view the contents of an intracardiac mass, LA myxomas in the patients studied could be more confi dently diagnosed by noting isolated echolucent areas consistent with hemorrhage/necrosis in the tumor mass.…”