CHAPTER 18: Cardiac Tumors and Masses

MALIGNANT CARDIAC TUMORS

• Scanning note: An unexplained pericardial effusion should always prompt a careful search for a cardiac tumor.

• Tumors that can metastasize to the heart: melanoma, breast cancer, lung cancer, ovarian cancer, uterine cancer, lymphoma, etc.

• Renal hypernephroma: A right atrial tumor should always prompt a careful scan of the inferior vena cava.

• Malignant primary cardiac tumors include angiosarcoma, leiomyosarcoma, synovial sarcoma, undifferentiated high-grade sarcoma.

Source

• Burke A. Primary malignant cardiac tumors. Semin Diagn Pathol. 2008;25:39–46.

LEFT ATRIAL MYXOMA

A benign tumor in a “malignant” location

• The most common location is in the left atrium (Fig. 18-1).

• The diagnosis is typically made by a sonographer.

• Not all myxomas are huge. Look for it in every “source of embolus” echo.

• 3D may help in finding the stalk attachment to the interatrial septum.

• TEE may be necessary in some cases to confirm the diagnosis.

• Treatment is surgical removal.

• Familial myxomas are called Carney complex.

LAMBL EXCRESCENCE

• This is a valvular strand.

• Echocardiographically smaller, thinner, and more filament-like than a papillary fibroelastoma.

• Lambl described the pathology as small filiform (needle-like) processes on the aortic valve in 1856.

Source

• Hurle JM, Garcia-Martinez V, Sanchez-Quintana D. Morphologic characteristics and structure of surface excrescences (Lambl’s excrescences) in the normal aortic valve. Am J Cardiol. 1986;58:1223–1227.

Hurle et al. studied aortic valves without cardiac disease (age range: birth to 91 years). Two types of excrescences, lamellar (layered) and filiform, were found.

Source

• Magarey FR. On the mode of formation of Lambl’s excrescences and their relation to chronic thickening of the mitral valve. J Path Bact. 1949;61:203–208.

Margerey studied mitral valves and postulated that the mechanism of formation is intimal damage due to mechanical trauma at the leaflet coaptation. On echo, they are most commonly found on the ventricular side of the aortic valve.

• Filiform excrescences can be attached to the nodules of Arantius and are commonly found on echo at the line of closure of aortic leaflets.

Source

• Kiavar M, Sadeghpour A, Bakhshandeh H, et al. Are prosthetic heart valve fibrin strands negligible? The associations and significance. J Am Soc Echocardiogr. 2009;22:890–894.