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.
Highlights
Cardiac masses have captured the attention since the beginning of echocardiography
Transesophageal echocardiography (TEE), commonly used when a valvular lesion is suspected, may become necessary to better characterize a cardiac tumor in terms of size, morphology, attachment site, extension and hemodynamic affects. Not infrequently, this role is taken by cardiac magnetic resonance imaging (MRI) or cardiac computed tomography (CT)
Papillary fibroelastomas (PFE) rank third in the prevalence of benign cardiac tumors in adults based on autopsy series [26] but may be more common based on echocardiographic studies and referral patterns [27]
Summary
Cardiac masses have captured the attention since the beginning of echocardiography. A key reason lies in the fact that the overall prevalence of primary cardiac tumors is exceedingly rare, less than 0.1% in large autopsy series [1, 2]. As widely available and applicable, echocardiography is the imaging technique of choice It can delineate multiple cardiac structures and characteristics of a mass such as its mobility, attachment and potential hemodynamic consequences. Transesophageal echocardiography (TEE), commonly used when a valvular lesion is suspected, may become necessary to better characterize a cardiac tumor in terms of size, morphology, attachment site, extension and hemodynamic affects. Not infrequently, this role is taken by cardiac magnetic resonance imaging (MRI) or cardiac computed tomography (CT). Embolic phenomena are an example of the latter and may be the clinical first presentation
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