The Echocardiographic Evaluation of Intracardiac Masses: A Review - ScienceDirect

Journal of the American Society of Echocardiography

Volume 19, Issue 2, February 2006, Pages 230-240

Journal of the American Society of Echocardiography

https://doi.org/10.1016/j.echo.2005.10.015 Get rights and content

Echocardiography is an invaluable procedure for the evaluation of intracardiac masses, and can reliably identify mass location, attachment, shape, size, and mobility, while defining the presence and extent of any consequent hemodynamic derangement. With careful attention to mass location and morphology, and appropriate application of clinical information, echocardiography can usually distinguish between the 3 principal intracardiac masses: tumor, thrombus, and vegetation. Transesophageal imaging frequently adds additional important information to the assessment of mass lesions and should always be considered when image quality is inadequate or pertinent clinical questions remain unanswered with surface imaging. This review will focus on primary and metastatic tumors of the heart.

Section snippets

Normal variants and mimickers

Numerous normal anatomic variants exist that can easily be confused with primary mass lesions. In the LV, webs and heartstrings, prominent or calcified papillary muscles, and dense mitral annular calcification¹ can mimic abnormal pathology (note: some LV cords may contain conduction fibers of the left bundle).2, 3 Prominent apical trabeculations, true ventricular noncompaction, and the apical form of hypertrophic cardiomyopathy can also be confused with tumors.4, 5, 6, 7 (Ventricular

Primary tumors

The first description of an intracardiac mass was published in 1559. Before 1960, cardiac tumors were rarely diagnosed before death. An accurate premortem diagnosis was not made until 1934, when a primary cardiac sarcoma was identified. The first successful resection of a cardiac myxoma was in 1954.22, 23, 24, 25, 26 Today, although still rare, cardiac tumors represent an important group of cardiovascular abnormalities that, at least in the case of myxoma, have the potential for complete cure

Metastatic tumors

Whereas primary tumors of the heart are rare, cardiac metastases have been described in up to 20% of patients with malignancies of other organ systems, and are up to 40 times more common than primary tumors.²⁹ No malignant tumor preferentially metastasizes to the heart, with the possible exception of malignant melanoma, which involves the heart in up to 50% of patients.⁶⁵ Cardiac metastases are encountered typically in patients with widespread systemic tumor dissemination; even in this setting,

References (89)

D. Harpaz et al.
Caseous calcification of the mitral annulusa neglected, unrecognized diagnosis
J Am Soc Echocardiogr
(2001)
G. Tamborini et al.
Incidence and characteristics of left ventricular false tendons and trabeculations in the normal and pathologic heart by second harmonic echocardiography
J Am Soc Echocardiogr
(2004)
Y. Agmon et al.
Noncompaction of the ventricular myocardium
J Am Soc Echocardiogr
(1999)
M.H. Lowery et al.
Noncompaction of the ventricular myocardiumthe use of contrast-enhanced echocardiography in the diagnosis
J Am Soc Echocardiogr
(2003)
C. Stollberger et al.
Left ventricular hypertrabeculation/noncompaction
J Am Soc Echocardiogr
(2004)
R.P. Ward et al.
Quantitative diagnosis of apical cardiomyopathy using contrast echocardiography
J Am Soc Echocardiogr
(2002)
H.R. Malaterre et al.
Right and left sided interatrial septal aneurysm mimicking atrial tumor and stroke
J Am Soc Echocardiogr
(1998)
L.L. Minich et al.
Inverted left atrial appendage presenting as an unusual left atrial mass
J Am Soc Echocardiogr
(1995)
D.M. Toma et al.
Inverted left atrial appendage mimicking a left atrial mass during mitral valve repair
J Am Soc Echocardiogr
(1995)
J. Pharr et al.
Prominent crista terminalis appearing as a right atrial mass on transthoracic echocardiogram
J Am Soc Echocardiogr
(2002)

A. Goldschlager et al.

Catheter entrapment in a Chiari network involving an atrial septal defect

Chest

(1972)

J. Cooke et al.

Chiari network entanglement and herniation into the left atrium by an atrial septal defect occluder device

J Am Soc Echocardiogr

(1999)

P. Harrity et al.

Intracardiac varices of the right atriuma case report and review of the literature

Int J Cardiol

(1995)

J. Shirani et al.

Clinical, electrocardiographic and morphologic features of massive fatty deposits (“lipomatous hypertrophy”) in the atrial septum

J Am Coll Cardiol

(1993)

W.C. Roberts

Primary and secondary neoplasms of the heart

Am J Cardiol

(1997)

S. Malekzadeh et al.

Growth rate of left atrial myxoma

Am J Cardiol

(1989)

E.J. Topol et al.

Cardiac papillary fibroelastoma and strokeechocardiographic diagnosis and guide to excision

Am J Cardiol

(1986)

R.L. Zamora et al.

Branch retinal artery occlusion caused by a mitral valve papillary fibroelastoma

Ophthalmology

(1995)

J.L. Bass et al.

Echocardiographic incidence of cardiac rhabdomyoma in tuberous sclerosis

Am J Cardiol

(1985)

H.A. Verhaaren et al.

Left ventricular outflow obstruction in rhabdomyoma of infancymeta-analysis of the literature

J Pediatr

(2003)

J.M. Cho et al.

Surgical resection of ventricular cardiac fibromasearly and late results

Ann Thorac Surg

(2003)

J.E. Bednarz et al.

Identification of cardiac masses and abnormal blood flow patterns with harmonic power Doppler contrast echocardiography

J Am Soc Echhocardiogr

(1999)

J.N. Kirkpatrick et al.

Differential diagnosis of cardiac masses using contrast echocardiographic perfusion imaging

J Am Coll Cardiol

(2004)

W. Lepper et al.

Assessment of the vascularity of a left ventricular mass using myocardial contrast echocardiography

J Am Soc Echocardiogr

(2002)

T. Tollens et al.

Fetal cardiac tamponade due to an intrapericardial teratomas

Ann Thorac Surg

(1998)

M. Okada et al.

An autopsy case of angiosarcoma arising around a woven Dacron prosthesis after a Cabrol operation

J Thorac Cardiovasc Surg

(2004)

N.M. Durrleman et al.

Cardiac lymphoma following mitral valve replacement

Ann Thorac Surg

(2005)

B.S. Fyfe et al.

Aortic sarcoma four years after Dacron graft insertion

Ann Thorac Surg

(1994)

J.C. Plana et al.

Cardiac angiosarcomaan unusual presentation simulating mitral stenosis and constrictive-effusive pericarditis

J Am Soc Echocardiogr

(2003)

S.M. Talbot et al.

Combined heart and lung transplantation for unresectable primary cardiac sarcoma

J Thorac Cardiovasc Surg

(2002)

B.V. Waller et al.

The “charcoal heart”melanoma to the cor

Chest

(1980)

W.H. Warren

Malignancies involving the pericardium

Semin Thorac Cardiovasc Surg

(2000)

W.C. Roberts

A unique heart disease associated with a unique cancercarcinoid heart disease

Am J Cardiol

(1997)

H.M. Connolly et al.

Outcome of cardiac surgery for carcinoid heart disease

J Am Coll Cardiol

(1995)

P.A. Robiolio et al.

Predictors of outcome of tricuspid valve replacement in carcinoid heart disease

Am J Cardiol

(1995)

P.M. Ridker et al.

Bioprosthetic tricuspid valve stenosis associated with extensive plaque deposition in carcinoid heart disease

Am Heart J

(1991)

U. Pandya et al.

Metastatic carcinoid tumor to the heartechocardiographic-pathologic study of 11 patients

J Am Coll Cardiol

(2002)

K. Ben-Hamda et al.

Eighteen year experience with Echinococcosus of the heartclinical and echocardiographic features in 14 patients

Int J Cardiol

(2003)

D. Atilgan et al.

Role of transesophageal echocardiography in diagnosis and management of cardiac hydatid cystreport of three cases and review of the literature

J Am Soc Echocardiogr

(2002)

F.C. Bandeira et al.

Cardiac tamponadean unusual complication of pericardial cyst

J Am Soc Echocardiogr

(1996)

F. Antonini-Canterin et al.

Value of transesophageal echocardiography in the diagnosis of compressive, atypically located pericardial cysts

J Am Soc Echocardiogr

(2002)

H.M.P. Pelikan et al.

Giant blood cyst of the mitral valve

J Am Soc Echocardiogr

(1999)

V. Nkomo et al.

Eustachian valve cyst

J Am Soc Echocardiogr

(2001)

E.K.W. Sim et al.

Blood cyst of the tricuspid valve

Ann Thorac Surg

(1996)

Cited by (0)

Copyright © 2006 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.