Abstract
Cardiac masses are space occupying lesions within the cardiac cavities or adjacent to the pericardium. They include frequently diagnosed clinical entities such as clots and vegetations, common benign tumors such as myxomas and papillary fibroelastomas and uncommon benign or malignant primary or metastatic tumors. Given their diversity, there are no guidelines or consensus statements regarding the best diagnostic or therapeutic approach. In the past, diagnosis used to be made by the histological specimens after surgery or during the post-mortem examination. Nevertheless, evolution and increased availability of cardiovascular imaging modalities has enabled better characterization of the masses and the surrounding tissue. Transthoracic echocardiography using contrast agents can evaluate the location, the morphology and the perfusion of the mass as well as its hemodynamic effect. Transesophageal echocardiography has increased spatial and temporal resolution; hence it is superior in depicting small highly mobile masses. Cardiac magnetic resonance and cardiac computed tomography are complementary providing tissue characterization. The scope of this review is to present the role of cardiovascular imaging in the differential diagnosis of cardiac masses and to propose a step-wise diagnostic algorithm, taking into account the epidemiology and clinical presentation of the cardiac masses, as well as the availability and the incremental value of each imaging modality.
Highlights
The diagnosis of space occupying lesions or masses in the heart can be done either in the context of investigation of a specific clinical symptomatology or incidentally, usually in the context of a cardiac imaging study performed for another reason
Cardiac masses can be classified as lesions that resemble tumors and as benign or malignant, primary or metastatic, intracardial, or pericardial tumors [1,2,3]
The scope of this review is to present the role of cardiovascular imaging in the differential diagnosis of cardiac masses and to propose a step-wise diagnostic algorithm, taking into account their epidemiology and clinical presentation, as well as the availability and the incremental value of each imaging modality
Summary
The diagnosis of space occupying lesions or masses in the heart can be done either in the context of investigation of a specific clinical symptomatology or incidentally, usually in the context of a cardiac imaging study performed for another reason. Cardiac masses can be classified as lesions that resemble tumors (clots, vegetations, calcifications or other rare lesions) and as benign or malignant, primary or metastatic, intracardial, or pericardial tumors [1,2,3]. The prevalence of primary cardiac tumors is 1:2000, while of metastatic 1:100 autopsies, reflecting a ratio of secondary to primary patients in the range of 20:1. Given the diversity of cardiac masses, (from clots or vegetations to primary or metastatic malignant tumors), there are no guidelines or consensus statements regarding the best diagnostic or therapeutic approach. The scope of this review is to present the role of cardiovascular imaging in the differential diagnosis of cardiac masses and to propose a step-wise diagnostic algorithm, taking into account their epidemiology and clinical presentation, as well as the availability and the incremental value of each imaging modality
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