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Cardiac tumors: echo assessment

Echo Research & Practice volume 3, pages R65–R77 (2016)Cite this article

Abstract

Cardiac tumors are exceedingly rare (0.001-0.03% in most autopsy series). They can be present anywhere within the heart and can be attached to any surface or be embedded in the myocardium or pericardial space. Signs and symptoms are nonspecific and highly variable related to the localization, size and composition of the cardiac mass. Echocardiography, typically performed for another indication, may be the first imaging modality alerting the clinician to the presence of a cardiac mass. Although echocardiography cannot give the histopathology, certain imaging features and adjunctive tools such as contrast imaging may aid in the differential diagnosis as do the adjunctive clinical data and the following principles: (1) thrombus or vegetations are the most likely etiology, (2) cardiac tumors are mostly secondary and (3) primary cardiac tumors are mostly benign. Although the finding of a cardiac mass on echocardiography may generate confusion, a stepwise approach may serve well practically. Herein, we will review such an approach and the role of echocardiography in the assessment of cardiac masses.

References

  1. Lam KY, Dickens P, Chan AC 1993 Tumors of the heart. A 20-year experience with a review of 12,485 consecutive autopsies. Archives of Pathology and Laboratory Medicine 117 1027–1031.

    CAS  PubMed  Google Scholar 

  2. Reynen K 1996 Frequency of primary tumors of the heart. American Journal of Cardiology 77 107. (doi:10.1016/S0002-9149(97)89149-7)

    CAS  Google Scholar 

  3. Kirkpatrick N, Wong T, Bednarz E, Spencer KT, Sugeng L, Ward RP, DeCara M, Weinert L, Krausz T, Lang RM 2004 Differential diagnosis of cardiac masses using contrast echocardiographic perfusion imaging. Journal of the American College of Cardiology 43 1412–1419. (doi:10.1016/j.jacc.2003.09.065)

    PubMed  Google Scholar 

  4. Mansencal N, Revault-d’Allonnes L, Pelage P, Farcot C, Lacombe P & Dubourg O 2009 Usefulness of contrast echocardiography for assessment of intracardiac masses. Archives of Cardiovascular Diseases 102 177–183. (doi:10.1016/j.acvd.2008.12.007)

    PubMed  Google Scholar 

  5. Zaragoza-Macias E, Chen MA, Gill EA 2012 Real time three-dimensional echocardiography evaluation of intracardiac masses. Echocardiography 29 207–219. (doi:10.1111/j.1540-8175.2011.01627.x)

    PubMed  Google Scholar 

  6. Elbardissi AW, Dearani A, Daly RC, Mullany CJ, Orszulak TA, Puga FJ, Schaff HV 2009 Embolic potential of cardiac tumors and outcome after resection: a case-control study. Stroke 40 156–162. (doi:10.1161/STROKEAHA.108.525709)

    PubMed  Google Scholar 

  7. Perez Baztarrica G, Nieva N, Gariglio L, Salvaggio F, Porcile R 2010 Images in cardiovascular medicine. Primary cardiac lymphoma: a rare case of pulmonary tumor embolism. Circulation 121 2249–2250. (doi:10.1161/CIRCULATIONAHA.109.863126)

    PubMed  Google Scholar 

  8. Cina SJ, Smialek E, Burke AP, Virmani R, Hutchins GM 1996 Primary cardiac tumors causing sudden death: a review of the literature. American Journal of Forensic Medicine and Pathology 17 271–281. (doi:10.1097/00000433-199612000-00001)

    CAS  Google Scholar 

  9. Salcedo EE, Cohen GI, White RD, Davison MB 1992 Cardiac tumors: diagnosis and management. Current Problems in Cardiology 17 73–137. (doi:10.1016/0146-2806(92)90025-J)

    CAS  PubMed  Google Scholar 

  10. Silvestri F, Bussani R, Pavletic N, Mannone T 1997 Metastases of the heart and pericardium. Giornale Italiano di Cardiologia 27 1252–1255.

    CAS  PubMed  Google Scholar 

  11. Larrieu AJ, Jamieson WR, Tyers GF, Burr LH, Munro AI, Miyagishima RT, Gerein AN, Allen P 1982 Primary cardiac tumors: experience with 25 cases. Journal of Thoracic and Cardiovascular Surgery 83 339–348.

    CAS  Google Scholar 

  12. Molina E, Edwards E, Ward HB 1990 Primary cardiac tumors: experience at the University of Minnesota. Thoracic and Cardiovascular Surgeon 38 (Supplement 2) 183–191. (doi:10.1055/s-2007-1014064)

    PubMed  Google Scholar 

  13. Tazelaar HD, Locke TJ, McGregor CG 1992 Pathology of surgically excised primary cardiac tumors. Mayo Clinic Proceedings 67 957–965. (doi:10.1016/S0025-6196(12)60926-4)

    CAS  PubMed  Google Scholar 

  14. Sarjeant M, Butany, Cusimano RJ 2003 Cancer of the heart: epidemiology and management of primary tumors and metastases. American Journal of Cardiovascular Drugs 3 407–421. (doi:10.2165/00129784-200303060-00004)

    PubMed  Google Scholar 

  15. St John Sutton MG, Mercier LA, Giuliani ER, Lie T 1980 Atrial myxomas: a review of clinical experience in 40 patients. Mayo Clinic Proceedings 55 371–376.

    CAS  PubMed  Google Scholar 

  16. Pinede L, Duhaut P, Loire R 2001 Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases. Medicine 80 159–172. (doi:10.1097/00005792-200105000-00002)

    CAS  PubMed  Google Scholar 

  17. Reynen K 1995 Cardiac myxomas. New England Journal of Medicine 333 1610–1617.

    CAS  Google Scholar 

  18. Javed A, Zalawadiya S, Kovach, Afonso L 2014 Aortic valve myxoma at the extreme age: a review of literature. BMJ Case Reports 2014 bcr2013202689. (doi:10.1136/bcr-2013-202689)

    Google Scholar 

  19. Lee VH, Connolly HM, Brown RD Jr 2007 Central nervous system manifestations of cardiac myxoma. Archives of Neurology 64 1115–1120. (doi:10.1001/archneur.64.8.1115)

    PubMed  Google Scholar 

  20. Carney A, Gordon H, Carpenter PC, Shenoy BV, Go VL 1985 The complex of myxomas, spotty pigmentation, and endocrine overactivity. Medicine 64 270–283. (doi:10.1097/00005792-198507000-00007)

    CAS  PubMed  Google Scholar 

  21. Vidaillet HJ Jr, Seward B, Fyke FE 3rd, Su WP, Tajik AJ 1987 sSyndrome myxoma’: a subset of patients with cardiac myxoma associated with pigmented skin lesions and peripheral and endocrine neoplasms. British Heart Journal 57 247–255. (doi:10.1136/hrt.57.3.247)

    PubMed  PubMed Central  Google Scholar 

  22. Keeling IM, Oberwalder P, Anelli-Monti M, Schuchlenz H, Demel U, Tilz GP, Rehak P, Rigler B 2002 Cardiac myxomas: 24 years of experience in 49 patients. European Journal of Cardio-Thoracic Surgery 22 971–977. (doi:10.1016/S1010-7940(02)00592-4)

    CAS  PubMed  Google Scholar 

  23. D’Alfonso A, Catania S, Pierri MD, Matteucci SL, Rescigno G, Mu¨nch C, Staine, Iacobone G, Piccoli GP 2008 Atrial myxoma: a 25-year single-institutional follow-up study. Journal of Cardiovascular Medicine 9 178–181. (doi:10.2459/jcm.0b013e3281ac22cb)

    PubMed  Google Scholar 

  24. Shah IK, Dearani A, Daly RC, Suri RM, Park SJ, Joyce LD, Li Z, Schaff HV 2015 Cardiac myxomas: a 50-year experience with resection and analysis of risk factors for recurrence. Annals of Thoracic Surgery 100 495–499. (doi:10.1016/j.athoracsur.2015.03.007)

    Google Scholar 

  25. Bhan A, Mehrotra R, Choudhary SK, Sharma R, Prabhakar D, Airan B, Kumar AS, Venugopal P 1998 Surgical experience with intracardiac myxomas: long-term follow-up. Annals of Thoracic Surgery 66 810–813. (doi:10.1016/S0003-4975(98)00591-8)

    CAS  Google Scholar 

  26. McAllister HA, Hall RJ, Cooley DA 1999 Tumors of the heart and pericardium. Current Problems in Cardiology 24 57–116. (doi:10.1016/S0146-2806(99)80001-2)

    PubMed  Google Scholar 

  27. Tamin SS, Maleszewski J, Scott CG, Khan SK, Edwards WD, Bruce CJ, Oh K, Pellikka PA, Klarich KW 2015 Prognostic and bioepidemiologic implications of papillary fibroelastomas. Journal of the American College of Cardiology 65 2420–2429. (doi:10.1016/j.jacc.2015.03.569)

    PubMed  Google Scholar 

  28. Klarich KW, Enriquez-Sarano M, Gura GM, Edwards WD, Tajik AJ, Seward B 1997 Papillary fibroelastoma: echocardiographic characteristics for diagnosis and pathologic correlation. Journal of the American College of Cardiology 30 784–790. (doi:10.1016/S0735-1097(97)00211-8)

    CAS  PubMed  Google Scholar 

  29. Gowda RM, Khan IA, Nair CK, Mehta NJ, Vasavada BC, Sacchi TJ 2003 Cardiac papillary fibroelastoma: a comprehensive analysis of 725 cases. American Heart Journal 146 404–410. (doi:10.1016/S0002-8703(03)00249-7)

    PubMed  Google Scholar 

  30. Sun P, Asher CR, Yang XS, Cheng GG, Scalia GM, Massed AG, Griffin BP, Ratliff NB, Stewart WJ, Thomas D 2001 Clinical and echocardiographic characteristics of papillary fibroelastomas: a retrospective and prospective study in 162 patients. Circulation 103 2687–2693. (doi:10.1161/01.CIR.103.22.2687)

    CAS  PubMed  Google Scholar 

  31. Bruce CJ 2011 Cardiac tumours: diagnosis and management. Heart 97 151–160. (doi:10.1136/hrt.2009.186320)

    PubMed  Google Scholar 

  32. Beghetti M, Gow RM, Haney I, Mawson, Williams WG, Freedom RM 1997 Pediatric primary benign cardiac tumors: a 15-year review. American Heart Journal 134 1107–1114. (doi:10.1016/S0002-8703(97)70032-2)

    CAS  PubMed  Google Scholar 

  33. Smythe F, Dyck D, Smallhorn F, Freedom RM 1990 Natural history of cardiac rhabdomyoma in infancy and childhood. Amerian Journal of Cardiology 66 1247–1249. (doi:10.1016/0002-9149(90)91109-J)

    CAS  Google Scholar 

  34. Jacobs P, Konstantakos AK, Holland FW 2nd, Herskowitz K, Ferrer PL, Perryman RA 1994 Surgical treatment for cardiac rhabdomyomas in children. Annals of Thoracic Surgery 58 1552–1555. (doi:10.1016/0003-4975(94)91963-1)

    CAS  Google Scholar 

  35. Elbardissi AW, Dearani A, Daly RC, Mullany CJ, Orszulak TA, Puga FJ, Schaff HV 2008 Survival after resection of primary cardiac tumors: a 48-year experience. Circulation 118 (Supplement 14) S7–S15. (doi:10.1161/CIRCULATIONAHA.107.783126)

    PubMed  Google Scholar 

  36. Basu S, Morshuis W, Heijmen R, Jaarsma W 1994 Lipomatous hypertrophy of the interatrial septum. Cardiovascular Surgery 2 229–231.

    CAS  PubMed  Google Scholar 

  37. Zeebregts CJ, Hensens AG, Timmermans, Pruszczynski MS, Lacquet LK 1997 Lipomatous hypertrophy of the interatrial septum: indication for surgery? European Journal of Cardio-Thoracic Surgery 11 785–787. (doi:10.1016/S1010-7940(96)01078-0)

    CAS  PubMed  Google Scholar 

  38. Cale R, Andrade MJ, Canada M, Hernandez-Estefania R, Lima S, Abecasis M, Vitorino E, Gouveia R, Gouveia R, Silva A 2009 Lipomatous hypertrophy of the interatrial septum: report of two cases where histological examination and surgical intervention were unavoidable. European Journal of Echocardiography 10 876–879. (doi:10.1093/ejechocard/jep080)

    PubMed  Google Scholar 

  39. Meng Q, Qian Y, Lai H, Lai S, Lima, Tong W 2002 Echocardiographic and pathologic characteristics of primary cardiac tumors: a study of 149 cases. International Journal of Cardiology 84 69–75. (doi:10.1016/S0167-5273(02)00136-5)

    PubMed  Google Scholar 

  40. Simpson L, Kumar SK, Okuno SH, Schaff HV, Porrata LF, Buckner C, Moynihan TJ 2008 Malignant primary cardiac tumors. Cancer 112 2440–2446. (doi:10.1002/cncr.23459)

    PubMed  Google Scholar 

  41. Vander Salm TJ 2000 Unusual primary tumors of the heart. Seminars in Thoracic and Cardiovascular Surgery 12 89–100. (doi:10.1053/ct.2000.5080)

    CAS  PubMed  Google Scholar 

  42. Kupsky DF, Newman DB, Kumar G, Maleszewski J, Edwards WD, Klarich KW 2016 Echocardiographic features of cardiac angiosarcomas: the mayo clinic experience (1976–2013). Echocardiography 33 186–192. (doi:10.1111/echo.13060)

    PubMed  Google Scholar 

  43. Neragi-Miandoab S, Kim J, Vlahakes GJ 2007 Malignant tumours of the heart: a review of tumour type, diagnosis and therapy. Clinical Oncology 19 748–756. (doi:10.1016/j.clon.2007.06.009)

    CAS  PubMed  Google Scholar 

  44. Burnside N, MacGowan SW 2012 Malignant primary cardiac tumours. Interactive Cardiovascular and Thoracic Surgery 15 1004–1006. (doi:10.1093/icvts/ivs350)

    PubMed  PubMed Central  Google Scholar 

  45. Bear PA, Moodie DS 1987 Malignant primary cardiac tumors. The Cleveland Clinic experience, 1956 to 1986. Chest 92 860–862. (doi:10.1378/chest.92.5.860)

    CAS  PubMed  Google Scholar 

  46. Butany J, Yu W 2000 Cardiac angiosarcoma: two cases and a review of the literature. Canadian Journal of Cardiology 16 197–205.

    CAS  Google Scholar 

  47. Truong PT, Jones SO, Martens B, Alexander C, Paquette M, Joe H, Hart J, Allan SJ 2009 Treatment and outcomes in adult patients with primary cardiac sarcoma: the British Columbia Cancer Agency experience. Annals of Surgical Oncology 16 3358–3365. (doi:10.1245/s10434-009-0734-8)

    PubMed  Google Scholar 

  48. Burke AP, Cowan D, Virmani R 1992 Primary sarcomas of the heart. Cancer 69 387–395. (doi:10.1002/1097-0142(19920115)69:2<387::AID-CNCR2820690219<3.0.CO;2-N)

    CAS  PubMed  Google Scholar 

  49. Roberts WC 1997 Primary and secondary neoplasms of the heart. American Journal of Cardiology 80 671–682. (doi:10.1016/S0002-9149(97)00587-0)

    CAS  Google Scholar 

  50. Okamoto K, Kato S, Katsuki S, Wada Y, Toyozumi Y, Morimatsu M, Aoyagi S, Imaizumi T 2001 Malignant fibrous histiocytoma of the heart: case report and review of 46 cases in the literature. Internal Medicine 40 1222–1226. (doi:10.2169/internalmedicine.40.1222)

    CAS  PubMed  Google Scholar 

  51. Centofanti P, Di Rosa E, Deorsola L, Dato GM, Patanè F, La Torre M, Barbato L, Verzini A, Fortunato G, di Summa M 1999 Primary cardiac tumors: early and late results of surgical treatment in 91 patients. Annals of Thoracic Surgery 68 1236–1241. (doi:10.1016/S0003-4975(99)00700-6)

    CAS  Google Scholar 

  52. Bakaeen FG, Michael JR, Joseph SC, Charles CM, Jimmy FH, Gerald ML, Rafael E, Mahesh KR, George PN, Donald GW, et al. 2003 Surgical outcome in 85 patients with primary cardiac tumors. American Journal of Surgery 186 641–647; discussion 647. (doi:10.1016/j.amjsurg.2003.08.004)

    PubMed  Google Scholar 

  53. Bakaeen FG, Jaroszewski DE, Rice DC, Walsh GL, Vaporciyan AA, Swisher SS, Benjamin R, Blackmon S, Reardon MJ 2009 Outcomes after surgical resection of cardiac sarcoma in the multimodality treatment era. Journal of Thoracic and Cardiovascular Surgery 137 1454–1460. (doi:10.1016/j.jtcvs.2008.11.026)

    Google Scholar 

  54. Petersen CD, Robinson WA, Kurnick JE 1976 Involvement of the heart and pericardium in the malignant lymphomas. American Journal of the Medical Sciences 272 161–165. (doi:10.1097/00000441-197609000-00005)

    CAS  Google Scholar 

  55. Ragland MM, Tak T 2006 The role of echocardiography in diagnosing space-occupying lesions of the heart. Clinical Medicine Research 4 22–32. (doi:10.3121/cmr.4.1.22)

    PubMed  PubMed Central  Google Scholar 

  56. Miguel CE, Bestetti RB 2011 Primary cardiac lymphoma. International Journal of Cardiology 149 358–363. (doi:10.1016/j.ijcard.2010.02.016)

    PubMed  Google Scholar 

  57. Grebenc ML, Rosado de Christenson ML, Burke AP, Green CE, Galvin JR 2000 Primary cardiac and pericardial neoplasms: radiologic-pathologic correlation. Radiographics 20 1073–1103; quiz 1110-1111, 1112. (doi:10.1148/radiographics.20.4.g00jl081073)

    CAS  PubMed  Google Scholar 

  58. Al-Mamgani A, Baartman L, Baaijens M, de Pree I, Incrocci L, Levendag PC 2008 Cardiac metastases. International Journal of Clinical Oncology 13 369–372. (doi:10.1007/s10147-007-0749-8)

    PubMed  Google Scholar 

  59. Reynen K, Kockeritz U, Strasser RH 2004 Metastases to the heart. Annals of Oncology 15 375–381. (doi:10.1093/annonc/mdh086)

    CAS  Google Scholar 

  60. Goldberg AD, Blankstein R, Padera RF 2013 Tumors metastatic to the heart. Circulation 128 1790–1794. (doi:10.1161/circulationaha.112.000790)

    PubMed  Google Scholar 

  61. Dujardin KS, Click RL, Oh TK 2000 The role of intraoperative transesophageal echocardiography in patients undergoing cardiac mass removal. Journal of the American Society of Echocardiography 13 1080–1083.

    CAS  PubMed  Google Scholar 

  62. Solla-Ruiz I, Villanueva-Benito I, Begoña Iglesias-Rodriguez M, Asorey-Veiga V, Pereira-Loureiro MA 2012 Hemoptysis as the presenting symptom in cardiac sarcoma. Revista Portuguesa de Cardiologia 31 463–464.

    PubMed  Google Scholar 

  63. Yang HS, Lee KS, Chaliki HP, Tazelaar HD, Lusk JL, Chandrasekaran K, &, Tajik AJ 2008 Anomalous insertion of the papillary muscle causing left ventricular outflow obstruction: visualization by real-time three-dimensional echocardiography. European Heart Journal: Cardiovascular Imaging 9 733–738.

    Google Scholar 

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  1. Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA

    Rekha Mankad MD & Joerg Herrmann MD

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  1. Rekha Mankad MD
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Correspondence to Joerg Herrmann MD.

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Mankad, R., Herrmann, J. Cardiac tumors: echo assessment. Echo Res Pract 3, R65–R77 (2016). https://doi.org/10.1530/ERP-16-0035

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Echo Research & Practice

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