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Cardiac Tumors Flashcards

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1
Q

Cardiac Tumors — epidemiology?

A

~25% are malignant
~75% are benign
myxoma (~50%) > metastasis (~20%) > lipoma (~10%) > papillary fibroelastoma (~10%)

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2
Q

Cardiac Tumors — features suggesting malignancy?

A

Invasion of extra-cardiac structures
Involvement of more than one cardiac chamber
Involvement of the right side of the heart
Tissue inhomogeneity
poor definition of borders
greater than 5cm diameter
presence of pericardial or pleural effusion

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3
Q

myxoma — epidemiological facts?

A

~50% of primary cardiac tumors in adulthood
more common in females — 3:1 (f:m)
7% with atypical behaviour — familial predisposition or as part of the Carney complex

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4
Q

Carney complex — facts?

A

autosomal dominant inheritance syndrome — myxomas, hyperpigmented skin lesions, extracardiac tumors (pituitary adenomas, breast fibroadenomas, melanotic schwannomas)

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5
Q

myxoma — appearance / MRI diagnosis?

A 
well defined, spherical, intracavitary mass
lobular contours, inhomogeneous
~25% broad-based
~75% pedunculated
Cine-SSFP: mobile
T1w: isointense to myocardium
T2w: hyperintense
CE+ less than myocardium
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6
Q

myxoma — clinical symptoms?

A

Symptoms are often unspecific

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7
Q

myxoma — complications?

A

obstruction
arrhythmia
embolic events
interference with mitral valve

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8
Q

myxoma — differential diagnosis (DDx)?

A 
thrombus
lipoma
papillary fibroelastoma
endocarditic vegetations
prominent crista terminalis
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9
Q

myxoma — therapy?

A

surgical removal

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10
Q

cardiac lipoma - definition ?

A

benign cardiac neoplasia

deriving from neoplastic proliferative adipocytes

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11
Q

cardiac lipoma — epidemiology?

A

2nd most common cardiac neoplasia in adulthood ~10%

equally common in female and male

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12
Q

myxoma — localisation?

A

~75% left atrium (LA) mostly atrial septum, fossa ovalis
~20% right atrium
~5% ventricles

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13
Q

cardiac lipoma — appearance / MRI diagnosis?

A 
mostly homogeneous encapsulated tumors
sometimes septa
T1w: hyperintense
T2w: hyperintense 
no contrast enhancement (CE-)
FS: hypointense
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14
Q

cardiac lipoma — localisation?

A

~50% subendocardial
~25% intramyocardial
~25% subepicardial
most often located in the right atrium

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15
Q

cardiac lipoma — clinical symptoms?

A

mostly asymptomatic

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16
Q

cardiac lipoma — complications?

A

arrhythmia

embolic events

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17
Q

cardiac lipoma — therapy?

A

case-dependant

surgical removal

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18
Q

cardiac lipoma — differential diagnosis (DDx) ?

A

thrombi
myxoma
papillary fibroelastoma
lipomatous hypertrophy of the atrial septum

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19
Q

lipomatous hypertrophy of the atrial septum — facts?

A 
characterised by fatty infiltration of the atrial septum
sparing of fossa ovalis
prevalence estimated 1-8%
incidence increasing with age
brown fat cells
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20
Q

papillary fibroelastoma — epidemiology?

A

3rd most common primary cardiac tumor in adulthood
~10% of all primary cardiac tumors
~70% of all primary heart valve tumors
peak age ~6th decade

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21
Q

papillary fibroelastoma — appearance / MRI diagnosis?

A 
usually < 2cm in size
pedunculated, sea-anemone like
T1w: hypointense
T2w: hyperintense 
CE-
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22
Q

papillary fibroelastoma — localisation ?

A

~90% on heart valves
~29% aortic, ~25% mitral, ~17% tricuspid, ~13% pulmonary valve
~10% somewhere else on endocard

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23
Q

papillary fibroelastoma — clinical symptoms ?

A

mostly asymptomatic

dependant on localisation

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24
Q

papillary fibroelastoma — complications ?

A 
obstruction (coronary ostium)
embolic events (eg TIA)
also paradoxical with PFO
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25
papillary fibroelastoma — aetiology ?
multiple different theories (harmatoma / thrombus) can develop after cardiac surgery associated with endothelial injury most probable mechanical irritation
26
papillary fibroelastoma — differential diagnosis (DDx) ?
thrombi endocarditic vegetations valvular myxoma
27
papillary fibroelastoma — therapy ?
case dependant | surgical removal
28
cardiac fibroma — what is it ?
harmatoma, consisting of fibroblasts, collagen and elastic fibres
29
cardiac fibroma — epidemiology ?
2nd most common primary cardiac tumor in childhood ~10% of all primary cardiac tumors in childhood ~15% of cardiac fibromas are diagnosed in adulthood
30
cardiac fibroma — appearance and MRI diagnosis ?
intramural calcifications in ~25% Cine-SSFP: isointense to myocardium T1w: isointense to myocardium T2w: mildly hyperintense in childhood, hypointense with increasing age and in adulthood (specific) no enhancement in first pass perfusion peripheral enhancement and hypointense core on LGE
31
cardiac fibroma — localisation ?
left ventricular free wall > right ventricular free wall > septum
32
cardiac fibroma — clinical symptoms ?
dependant on localisation and implications arrhythmia outflow obstruction ischemia
33
cardiac fibroma — complications ?
arrhythmia ischemia outflow obstruction sudden death
34
cardiac fibroma — therapy ?
case dependant asymptomatic — no therapy because of complicated surgery symptomatic — surgical removal
35
cardiac fibroma — prognosis?
no tendency of spontaneous regression increase of collagen fibres with age (T2w increasingly hypointense) septal localisation, large size, young age have worse prognosis
36
cardiac fibroma — differential diagnosis (DDx) ?
``` cardiac rhabdomyoma hypertrophic cardiomyopathy (HCM) hemangioma ```
37
cardiac hemangioma — facts ?
non-neoplastic venous malformation | ~50% cavernous
38
cardiac hemangioma — epidemiology ?
~3% of all cardiac tumors
39
cardiac hemangioma — appearance, MRI diagnosis ?
T1w: isointense T2w: hyperintense, homogeneous fast wash in in first pass perfusion
40
cardiac hemangioma — clinical symptoms ?
variable | dependant on size, localisation and implications
41
cardiac hemangioma — complications ?
arrhythmia pericardial effusion / haemorrhage cerebral apoplex
42
cardiac hemangioma — therapy ?
case dependant | surgical resection
43
cardiac hemangioma — differential diagnosis (DDx) ?
all cardiac tumors | rhabomyoma
44
cardiac lymphoma — facts ?
primary cardiac lymphoma non Hodgkin lymphoma (NHL), B-cell lymphoma associated with immunosuppression
45
cardiac lymphoma — epidemiology ?
~1.3% of all cardiac tumors | age peak of~60 years
46
cardiac lymphoma — appearance, MRI diagnosis ?
T1w: isointense T2w: hyperintense CE+ diffusion restriction
47
cardiac lymphoma — clinical symptoms ?
B-symptoms | fatigue, weight loss, night-sweats
48
cardiac lymphoma — complications ?
pericardial effusion pericardial tamponade heart failure arrhythmia
49
cardiac lymphoma — therapy ?
chemotherapy: Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Prednisolone (R-CHOP) autologous stem cell transplant
50
cardiac lymphoma — differential diagnosis (DDx) ?
sarcoma amyloidosis sarcoidosis
51
cardiac angiosarcoma — epidemiology ?
most common primary malignant cardiac tumor ~30% male > female — 2-3:1 peak age 4th decade
52
cardiac angiosarcoma — localisation ?
``` right atrium (RA) most common two types: intracavitary growth infiltration of the pericard ```
53
cardiac angiosarcoma — appearance, MRI diagnosis ?
two types: intracavitary growth, infiltration of the pericard T1w: isointense with hyperintense spots and flow voids T2w: hyperintense CE+
54
cardiac angiosarcoma — clinical symptoms ?
unspecific | dependant on subtype
55
cardiac angiosarcoma — complications ?
right heart failure | pericardial effusion / haemorrhage / tamponade
56
cardiac angiosarcoma — therapy ?
multimodal
57
cardiac angiosarcoma — differential diagnosis (DDx) ?
- all malignant cardiac tumors - cardiac lymphoma (respects more anatomical structures) - Erdheim-Chester-disease (respects anatomical structures)
58
cardiac rhabdomyosarcoma — epidemiology ?
most common malignant cardiac tumor in childhood | ~20% of all primary malignant cardiac tumors
59
cardiac rhabdomyosarcoma — appearance, MRI diagnosis ?
``` infiltrative growth necrotic areas often multiple locations T1w: isointense T2w: hyperintense CE+ inhomogenous enhancement ```
60
cardiac rhabdomyosarcoma — clinical symptoms & complications ?
unspecific symptoms: fatigue, weight loss dependant on localisation: outflow obstruction pericardial effusion
61
cardiac rhabdomyosarcoma — therapy and prognosis ?
Therapy : surgical resection — often not entirely possible | Prognosis : often death within a year
62
cardiac metastasis — epidemiology ?
2nd most common cardiac tumor after myxoma up to 40 times more common than primary malignant cardiac tumors in 3-18% of all patients with malignancies absolutely most frequent in breast and lung cancer relatively most frequent in melanoma
63
cardiac metastasis — appearance, MRI diagnosis ?
``` intramural or intracavitary often multiple T1w: hypo or isointense T2w: hyperintense CE+ T1 hyperintense, T2 hypointense (melanoma) ```
64
cardiac metastasis — localisation ?
RV>LV>RA>LA
65
cardiac metastasis — therapy
usually chemotherapy because of late stage
66
cardiac metastasis — differential diagnosis (DDx) ?
myxoma thrombi primary malignant cardiac tumors
67
cardiac thrombus — epidemiology ?
most frequent intracavitary tumor like lesion | incidence between 3-21% depending on age
68
cardiac thrombus — aetiology and pathophysiology ?
intracavitary areas with low blood flow or stasis atrial fibrillation, mitral stenosis myocardial infarction, left ventricular aneurysm cardiomyopathy
69
cardiac thrombus — localisation / predilection sites ?
left atrial appendage — atrial fibrillation, mitral stenosis | left ventricular apex — myocardial infarction, aneurysm
70
cardiac thrombus — diagnosis ?
dependant on localisation left atrium / left atrial appendage — TEE (CT) left ventricle — MRI (CT)
71
cardiac thrombus — MRI findings ?
early LGE: intracavitary filling defect acute thrombi: T1w and T2w intermediary subacute thrombi: T1w hyperintense, T2w hypointense (methemoglobin) chronic thrombi: T1w and T2w hypointense (fibrous remodeling)
72
cardiac thrombus — complications ?
embolic events | ~15% of ischaemic cerebral infarcts
73
cardiac thrombus — therapy ?
anticoagulation | left atrial clipping
74
Cardiac masses — role of MRI ?
I1 Indication - confirmation of presence and localisation of cardiac tumors - assessment of tumour size and locoregional extension - mass characterisation (T1w, T2w, T1wCE, EGE, LGE) - assessment of haemodynamic effect - surgical therapy planning
75
Cardiac masses - assessment ?
- confirmation of a mass / tumour - location and anatomical relationship - size - form and margins - motion and functional significance - tissue characteristics (T1, T2, CE) - tumour associated complications - features suggesting malignancy - differentiation
76
Cardiac masses - indicators of benignancy ?
- origin in left atrium - single lesion - smooth margins - encapsulated lesion - endocavitary growth
77
Cardiac masses - non-neoplastic origin ?
- normal or hypertrophic cardiac structures (e.g. crista terminalis) - echocardiographic artefacts - thrombi - intraparietal haematoma - pseudoaneurysms - granulomatous disease - focal hypertrophic cardiomyopathy
78
Cardiac paraganglioma - facts ?
- T2w hyperintense - rich vascular supply - LA>RA>aortic bulb - catecholamine production - DDx: cardiac hemangioma

Cardiac Imaging (9 decks)

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