19. Cardiac Masses and Embolic Sources Flashcards
Benign Cardiac Tumors, Types
Overall, rare (25% total cardiac neoplasm). Metastatic more likely.
1) Myxoma (30% primary cardiac tumors)
- Left atrium (occasionally RA or ventricles)
- Attaches to fossa ovalis from left atrial side
- Obstructs mitral valve flow
- Slow growing, pedunculated, large, smooth
- Friable and embolize
2) Lipoma (10%)
- Usually ventricle origin (LV free wall) occasional atrial
- Sessile, increased echogenicity, smooth
- Slow growing, large
- Distinguish from lipomatous hypertrophy
3) Papillary Fibroelastoma
- Small, pedunculated, mobile, echogenic
- Originate at valve leaflets, occasionally
endocardium (AV, then MV)
- High risk of embolism
- Mistaken for vegetations
* Fibroelastoma grow on aortic side of AV,
vs. ventricular side as vegetations
4) Rhabdmyoma (most common in kids)
- Strong associated with tuberous sclerosis
- Arise from ventricles (often multiple) usually RV
- Large, cause obstruction
- May spontaneously resolve
5) Fibroma (2nd common in kids)
- Originate in ventricles or AV groove
- Large single mass with central calcification
Lambl Excrescences
- Small fibrous core covered by endothelial cells attached to commissural edge of valve leaflets
- No risk of embolic events
Cardiac Sarcomas
- Malignant cardiac tumors
- Originate from ventricular myocardium
- Large and invade surrounding tissue
- Enhance with ultrasound contrast due to
vascularity
Common non-cardiac tumor that embolizes to heart
Renal cell carcinoma
New vs Chronic Thrombus
Acute:
- Round, mobile
Chronic:
- Flat, non-mobile
LAA Anatomy
- Extension of left atrial cavity originating anterior to insertion of left upper pulmonary vein
- Lined with pectinate muscle
- Two or more lobes
Risk factors for embolism of vegetations
- Mobility
- Size >1cm
Angiosarcoma
- most common malignant cardiac tumor
- often arise from RA
