Chapter 32 - Cardiac and Vascular Tumors

Abstract

Cardiac tumors are uncommon but tend to be symptomatic, even when benign. The goal of imaging in cardiac tumors is anatomical localization, tissue characterization or differential diagnosis and distinction from benign conditions and anatomical variants. Among primary cardiac tumors, 90% tend to be benign, with myxoma being the most common, followed by cardiac lipoma. Myxomas most commonly arise from the left atrium, in the region of the interatrial septum, followed by the right atrium, right ventricle, left ventricle, and rarely the valves. Other benign tumors of the heart include fibroma, hemangioma, cardiac paraganglioma, and papillary fibroelastoma. Among malignant lesions, metastasis are 30 to 40 times more common than primary lesions. Lung cancer is the most common primary malignancy to metastasize to the heart, followed by lymphoma, leukemia, breast cancer, and esophageal cancer. Sarcomas are the most common primary malignant tumors of the heart, followed by lymphoma, and overall angiosarcomas are the most common intracardiac malignancy of adulthood. Angiosarcomas are more common in the right side of the heart, usually arise from the lateral wall of the right atrium, and grow across the right atrioventricular groove into the right ventricle. Other sarcomas tend to arise from the left atrium, a rather common site of origin for sarcomas. Pericardial cysts are benign lesions, usually found incidentally. Pericardial mesothelioma is extremely rare but is the most common primary malignancy of the pericardium.