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Primary cardiac lymphoma

Introduction Primary cardiac lymphoma (PCL) is an extranodal lymphoma which involves the heart and pericardium. It is a very rare tumor, representing 0.5% of all extranodal lymphomas and 1%–2% of primary cardiac tumors . PCL is most frequently detected in immune-compromised patients , predominantly in males (3:1 ratio) , with a median age of occurrence of 63 years although it can develop at any age .…

Oncologic essentials in malignant cardiac masses (approach and follow-up)

Key points Malignant tumors are extremely rare. 25% of primary cardiac tumors are malignant. Most malignant cardiac tumors are metastatic (from breast, lung, melanoma, soft tissue sarcoma, etc.). Sarcoma, lymphoma, and malignant pericardial mesothelioma are three main primary malignant cardiac tumors. Usual imaging studies consist of TTE, CMR, and contrast TTE that are helpful noninvasive tools to diagnose suspicious cardiac masses. Generally, despite multimodal treatment strategies,…

Differential diagnosis of cardiac masses by operation view

Key points Most patients with cardiac masses are asymptomatic; however, they may present with symptomatology and clinical signs suggestive of more common and rapidly debilitating syndromes such as angina, myocardial infarct, or cerebrovascular insufficiency. Therefore the presence of an intramural or intracavitary mass is usually detected on imaging undertaken to rule out other structural pathologies, such as valvular disease. A sequential approach to imaging that allows…

CMR for malignant cardiac tumors: Diagnosis, approach, and follow-up

Key points Cardiac magnetic resonance (CMR) is the gold standard noninvasive imaging modality to assess tissue characteristics in vivo which gives it a unique advantage in discriminating benign cardiac masses from malignant tumors. CMR also provides visualization of tumor invasion, hemodynamic effects, and location relative to surrounding cardiac and extracardiac structures. These features make CMR an essential tool for diagnosis and management of cardiac tumors. The…

CMR in benign cardiac tumors (diagnosis, approach, and follow-up)

Key points Cardiac magnetic resonance (CMR) is a robust technique in the evaluation of cardiac mass. The advantage of CMR includes the large field of view, superior tissue contrast, multiplanar reconstruction, and unique ability to discriminate tissue characteristics. CMR core protocol for assessment of cardiac mass includes cine SSFP, T1-W, T2-W, first pass perfusion, postcontrast T1-W, and late gadolinium enhancement (LGE) sequences. Strong early contrast enhancement…

CT in malignant cardiac tumors (diagnosis, approach, follow-up)

Key points Cardiac CT has several advantages including wide availability, rapid acquisition time, excellent isotropic spatial resolution, and multiplanar reconstruction capabilities. CT is a robust technique for assessment of the relationship of the mass to the myocardium, cardiac valves, pericardium, coronary arteries, great vessels including pulmonary and systemic, and adjacent tissues, such as lung and lymph nodes, in a way that no other imaging modality can…

CT in benign cardiac tumors (diagnosis, approach, and follow-up)

Key points CT has emerged as an important imaging modality in the evaluation of cardiac and paracardiac neoplasms. CT has several advantages including wide availability, rapid acquisition time, excellent isotropic spatial resolution, and multiplanar reconstruction capabilities. CT is a robust technique for assessment of the relationship of the mass to the myocardium, cardiac valves, pericardium, coronary arteries, great vessels including pulmonary and systemic, and adjacent tissues,…

Contrast echocardiography in cardiac masses

Key points Newer echocardiographic techniques may provide incremental information to help characterize cardiac masses. Myocardial contrast echocardiography allows an improved definition of intracavity structures and an assessment of vascularity. The difference in the perfusion of cardiac masses may help distinguish between vascular tumors and nonvascular tumors or thrombi. Contrast agents improve the opacification of the cardiac cavities and the delineation of the endocardial borders in addition…

Echocardiography in malignant cardiac tumors (diagnosis, approach, and follow-up)

Key points Most malignant cardiac tumors are metastatic, most commonly from lung and breast carcinomas, melanomas, soft tissue sarcomas, and renal carcinomas. Malignant primary cardiac tumors are rare and mostly consist of various sarcomas and lymphomas. Twenty-five percent of primary cardiac tumors are malignant. Echocardiography is a readily available, portable, low-cost imaging modality that gives the first clue as to the etiology of a cardiac mass.…

Infectious lesions mimicking cardiac masses

Key points Vegetations are oscillating or nonoscillating intracardiac masses on the valves or other endocardial structures or intracardiac implanted materials. Vegetations are typically located on the upstream side of the valves, are usually irregularly and grotesquely shaped, and exhibit disordered motions that are not in pattern with the excursion of the valve leaflets. Abscesses are thick, nonhomogeneous, echolucent, or echodense perivalvular areas. Three echocardiographic findings are…