Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ KEY FEATURES +++ ESSENTIALS OF DIAGNOSIS ++ Evidence of tumors elsewhere in the body, especially melanoma, bronchogenic carcinoma, breast cancer, lymphoma, and leukemia Positive imaging study for characteristic cardiac masses Positive biopsy, usually of the primary tumor or metastases in other organs +++ GENERAL CONSIDERATIONS ++ Metastatic tumors are the most common type of cardiac tumors Bronchogenic and breast cancers spread to the heart by direct extension and usually involve the pericardium Lymphoma and leukemia reach the heart by hematogenous spread and usually involve the myocardium Malignant melanoma is an unusual tumor but has a predilection for cardiac involvement Endocardial metastases most often occur with renal cell carcinoma and adenocarcinoma from abdominal organs Renal cell carcinoma can extend from the renal vein up the inferior vena cava and appear in the right atrium +++ CLINICAL PRESENTATION +++ SYMPTOMS AND SIGNS ++ Symptoms and signs of the primary tumor usually predominate The most common cardiac presentation is pericardial tamponade due to tumor involvement of the pericardium Patients with myocardial and endocardial metastases may present with signs of heart failure due to ventricular dysfunction Chest pain and arrhythmias are common +++ PHYSICAL EXAM FINDINGS ++ Findings related to the primary tumor predominate Evidence of pericardial involvement with a pericardial friction rub or signs of tamponade such as elevated jugular venous pressure and pulsus paradoxus Findings of heart failure may occur +++ DIFFERENTIAL DIAGNOSIS ++ Primary cardiac tumors: metastatic tumors are 30 times more common Thrombus: renal cell carcinoma may grow up the inferior vena cava and mimic thrombus in the right atrium Vegetations; flail or prolapsing cardiac valves Pericardial cysts Giant aneurysm of the coronary artery Diaphragmatic hernia can mimic left atrial mass on transthoracic echocardiography Lipomatous infiltration Normal anatomic variants: – Chiari network – Eustachian valve – Septum spurium – Thebesian valve – Left superior pulmonary vein – Atrial septal aneurysm +++ DIAGNOSTIC EVALUATION +++ LABORATORY TESTS ++ Characteristic findings of neoplasia, such as anemia +++ ELECTROCARDIOGRAPHY ++ Findings depend on the structures involved – Loss of myocardium may appear as infarction-like Q waves – Pericarditis can result in classic diffuse ST elevation – The most common finding is nonspecific ST-T–wave abnormalities +++ IMAGING STUDIES ++ Echocardiography is not particularly good at defining myocardial involvement – Visualization of pericardial metastases is limited, although it can readily detect pericardial fluid and tamponade CT and MRI are superior for defining myocardial, pericardial, and paracardiac tumors – MRI can characterize tissue, especially fat, which is valuable for distinguishing lipomatous infiltration from tumors – 18F-Fluorodeoxyglucose positron emission tomography (PET) can be used to detect distant metastases – Integrating PET with MRI can help ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.