Cardiac tumors differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Cardiac tumors}}
{{CMG}} {{AE}} {{HK}}
{{CMG}} {{AE}} {{HK}}


==Overview==
==Overview==
Cardiac tumors present as a cardiac mass on imaging. Different types of cardiac tumors such as myxomas, rhabdomyomas, fibroelastomas, cardiac fibromas, cardiac hemangiomas, cardiac lipomas, paragangiomas and atrioventricular nodal tumors are classified as benign tumors of the heart. These can be differentiated based on age of presentation, location, morphological features on echocardiography and MRI findings. Malignant tumors of the heart include rhabdomyosarcoma, angiosarcoma, fibrosarcoma and lymphoma. Malignant cardiac tumors also have varying morphological features and MRI findings, which may aid in differentiating these tumors.
*The cardiac tumors have some common features like fever, weight loss, and other constitutional symptoms. Each tumor has its peculiar characteristics that sets it apart from other tumors.
 
==Differenting Cardiac Tumors from Other Diseases==
*[[Primary cardiac tumors]] have been divided into two categories: benign and malignant.
* Both [[benign]] and [[malignant]] tumors can be differentiated based on age of presentation, location, morphological features on [[echocardiography]] and [[MRI]] findings.
*Cardiac MRI is the most useful assessment tool.<ref name="pmid24717305">{{cite journal| author=Hoffmeier A, Sindermann JR, Scheld HH, Martens S| title=Cardiac tumors--diagnosis and surgical treatment. | journal=Dtsch Arztebl Int | year= 2014 | volume= 111 | issue= 12 | pages= 205-11 | pmid=24717305 | doi=10.3238/arztebl.2014.0205 | pmc=3983698 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24717305  }} </ref>
{| class="wikitable"
|+ Primary Cardiac Tumors
|-
! Benign !! Malignant
|-
| Myxoma|| Rhabdomyosarcoma
|-
| Rhabdomyoma || Angiosarcoma
|-
| Fibroelastoma|| Fibrosarcoma
|-
| Cardiac Lipoma || Lymphoma
|-
| Cardiac Hemangioma||
|-
| Cardiac Fibroma ||
|-
| Atrioventricular tumors ||
|-
| Paragangliomas ||
|-
|}
 
==Differential Diagnosis of Cardiac Mass==
==Differential Diagnosis of Cardiac Mass==
Cardiac tumors present as a cardiac mass on imaging. The following are the differentials of cardiac mass:<ref name="pmid27600455">{{cite journal |vauthors=Mankad R, Herrmann J |title=Cardiac tumors: echo assessment |journal=Echo Res Pract |volume=3 |issue=4 |pages=R65–R77 |date=December 2016 |pmid=27600455 |pmc=5292983 |doi=10.1530/ERP-16-0035 |url=}}</ref><ref name="pmid22283202">{{cite journal |vauthors=Zaragoza-Macias E, Zaragosa-Macias E, Chen MA, Gill EA |title=Real time three-dimensional echocardiography evaluation of intracardiac masses |journal=Echocardiography |volume=29 |issue=2 |pages=207–19 |date=February 2012 |pmid=22283202 |doi=10.1111/j.1540-8175.2011.01627.x |url=}}</ref><ref name="pmid7062746">{{cite journal |vauthors=Larrieu AJ, Jamieson WR, Tyers GF, Burr LH, Munro AI, Miyagishima RT, Gerein AN, Allen P |title=Primary cardiac tumors: experience with 25 cases |journal=J. Thorac. Cardiovasc. Surg. |volume=83 |issue=3 |pages=339–48 |date=March 1982 |pmid=7062746 |doi= |url=}}</ref><ref name="pmid2237900">{{cite journal |vauthors=Molina JE, Edwards JE, Ward HB |title=Primary cardiac tumors: experience at the University of Minnesota |journal=Thorac Cardiovasc Surg |volume=38 Suppl 2 |issue= |pages=183–91 |date=August 1990 |pmid=2237900 |doi=10.1055/s-2007-1014064 |url=}}</ref><ref name="pmid1434856">{{cite journal |vauthors=Tazelaar HD, Locke TJ, McGregor CG |title=Pathology of surgically excised primary cardiac tumors |journal=Mayo Clin. Proc. |volume=67 |issue=10 |pages=957–65 |date=October 1992 |pmid=1434856 |doi= |url=}}</ref><ref name="pmid14728061">{{cite journal |vauthors=Sarjeant JM, Butany J, Cusimano RJ |title=Cancer of the heart: epidemiology and management of primary tumors and metastases |journal=Am J Cardiovasc Drugs |volume=3 |issue=6 |pages=407–21 |date=2003 |pmid=14728061 |doi=10.2165/00129784-200303060-00004 |url=}}</ref><ref name="pmid7382545">{{cite journal |vauthors=St John Sutton MG, Mercier LA, Giuliani ER, Lie JT |title=Atrial myxomas: a review of clinical experience in 40 patients |journal=Mayo Clin. Proc. |volume=55 |issue=6 |pages=371–6 |date=June 1980 |pmid=7382545 |doi= |url=}}</ref><ref name="pmid11388092">{{cite journal |vauthors=Pinede L, Duhaut P, Loire R |title=Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases |journal=Medicine (Baltimore) |volume=80 |issue=3 |pages=159–72 |date=May 2001 |pmid=11388092 |doi= |url=}}</ref><ref name="pmid7477198">{{cite journal |vauthors=Reynen K |title=Cardiac myxomas |journal=N. Engl. J. Med. |volume=333 |issue=24 |pages=1610–7 |date=December 1995 |pmid=7477198 |doi=10.1056/NEJM199512143332407 |url=}}</ref><ref name="pmid24642215">{{cite journal |vauthors=Javed A, Zalawadiya S, Kovach J, Afonso L |title=Aortic valve myxoma at the extreme age: a review of literature |journal=BMJ Case Rep |volume=2014 |issue= |pages= |date=March 2014 |pmid=24642215 |pmc=3962858 |doi=10.1136/bcr-2013-202689 |url=}}</ref><ref name="pmid17698701">{{cite journal |vauthors=Lee VH, Connolly HM, Brown RD |title=Central nervous system manifestations of cardiac myxoma |journal=Arch. Neurol. |volume=64 |issue=8 |pages=1115–20 |date=August 2007 |pmid=17698701 |doi=10.1001/archneur.64.8.1115 |url=}}</ref><ref name="pmid4010501">{{cite journal |vauthors=Carney JA, Gordon H, Carpenter PC, Shenoy BV, Go VL |title=The complex of myxomas, spotty pigmentation, and endocrine overactivity |journal=Medicine (Baltimore) |volume=64 |issue=4 |pages=270–83 |date=July 1985 |pmid=4010501 |doi= |url=}}</ref><ref name="pmid10028128">{{cite journal |vauthors=McAllister HA, Hall RJ, Cooley DA |title=Tumors of the heart and pericardium |journal=Curr Probl Cardiol |volume=24 |issue=2 |pages=57–116 |date=February 1999 |pmid=10028128 |doi= |url=}}</ref><ref name="pmid9283541">{{cite journal |vauthors=Klarich KW, Enriquez-Sarano M, Gura GM, Edwards WD, Tajik AJ, Seward JB |title=Papillary fibroelastoma: echocardiographic characteristics for diagnosis and pathologic correlation |journal=J. Am. Coll. Cardiol. |volume=30 |issue=3 |pages=784–90 |date=September 1997 |pmid=9283541 |doi= |url=}}</ref><ref name="pmid26046736">{{cite journal |vauthors=Tamin SS, Maleszewski JJ, Scott CG, Khan SK, Edwards WD, Bruce CJ, Oh JK, Pellikka PA, Klarich KW |title=Prognostic and Bioepidemiologic Implications of Papillary Fibroelastomas |journal=J. Am. Coll. Cardiol. |volume=65 |issue=22 |pages=2420–9 |date=June 2015 |pmid=26046736 |doi=10.1016/j.jacc.2015.03.569 |url=}}</ref><ref name="pmid12947356">{{cite journal |vauthors=Gowda RM, Khan IA, Nair CK, Mehta NJ, Vasavada BC, Sacchi TJ |title=Cardiac papillary fibroelastoma: a comprehensive analysis of 725 cases |journal=Am. Heart J. |volume=146 |issue=3 |pages=404–10 |date=September 2003 |pmid=12947356 |doi=10.1016/S0002-8703(03)00249-7 |url=}}</ref><ref name="pmid9424072">{{cite journal |vauthors=Beghetti M, Gow RM, Haney I, Mawson J, Williams WG, Freedom RM |title=Pediatric primary benign cardiac tumors: a 15-year review |journal=Am. Heart J. |volume=134 |issue=6 |pages=1107–14 |date=December 1997 |pmid=9424072 |doi= |url=}}</ref><ref name="pmid2239731">{{cite journal |vauthors=Smythe JF, Dyck JD, Smallhorn JF, Freedom RM |title=Natural history of cardiac rhabdomyoma in infancy and childhood |journal=Am. J. Cardiol. |volume=66 |issue=17 |pages=1247–9 |date=November 1990 |pmid=2239731 |doi= |url=}}</ref><ref name="pmid7979700">{{cite journal |vauthors=Jacobs JP, Konstantakos AK, Holland FW, Herskowitz K, Ferrer PL, Perryman RA |title=Surgical treatment for cardiac rhabdomyomas in children |journal=Ann. Thorac. Surg. |volume=58 |issue=5 |pages=1552–5 |date=November 1994 |pmid=7979700 |doi= |url=}}</ref><ref name="pmid18824772">{{cite journal |vauthors=Elbardissi AW, Dearani JA, Daly RC, Mullany CJ, Orszulak TA, Puga FJ, Schaff HV |title=Survival after resection of primary cardiac tumors: a 48-year experience |journal=Circulation |volume=118 |issue=14 Suppl |pages=S7–15 |date=September 2008 |pmid=18824772 |doi=10.1161/CIRCULATIONAHA.107.783126 |url=}}</ref><ref name="pmid8049952">{{cite journal |vauthors=Basu S, Folliguet T, Anselmo M, Greengart A, Sabado M, Cunningham JN, Jacobowitz IJ |title=Lipomatous hypertrophy of the interatrial septum |journal=Cardiovasc Surg |volume=2 |issue=2 |pages=229–31 |date=April 1994 |pmid=8049952 |doi= |url=}}</ref><ref name="pmid18428209">{{cite journal |vauthors=Simpson L, Kumar SK, Okuno SH, Schaff HV, Porrata LF, Buckner JC, Moynihan TJ |title=Malignant primary cardiac tumors: review of a single institution experience |journal=Cancer |volume=112 |issue=11 |pages=2440–6 |date=June 2008 |pmid=18428209 |doi=10.1002/cncr.23459 |url=}}</ref><ref name="pmid10807431">{{cite journal |vauthors=Vander Salm TJ |title=Unusual primary tumors of the heart |journal=Semin. 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Cardiac tumors present as a cardiac mass on imaging. The following are the differentials of cardiac mass:<ref name="pmid27600455">{{cite journal |vauthors=Mankad R, Herrmann J |title=Cardiac tumors: echo assessment |journal=Echo Res Pract |volume=3 |issue=4 |pages=R65–R77 |date=December 2016 |pmid=27600455 |pmc=5292983 |doi=10.1530/ERP-16-0035 |url=}}</ref><ref name="pmid22283202">{{cite journal |vauthors=Zaragoza-Macias E, Zaragosa-Macias E, Chen MA, Gill EA |title=Real time three-dimensional echocardiography evaluation of intracardiac masses |journal=Echocardiography |volume=29 |issue=2 |pages=207–19 |date=February 2012 |pmid=22283202 |doi=10.1111/j.1540-8175.2011.01627.x |url=}}</ref><ref name="pmid7062746">{{cite journal |vauthors=Larrieu AJ, Jamieson WR, Tyers GF, Burr LH, Munro AI, Miyagishima RT, Gerein AN, Allen P |title=Primary cardiac tumors: experience with 25 cases |journal=J. Thorac. Cardiovasc. Surg. |volume=83 |issue=3 |pages=339–48 |date=March 1982 |pmid=7062746 |doi= |url=}}</ref><ref name="pmid2237900">{{cite journal |vauthors=Molina JE, Edwards JE, Ward HB |title=Primary cardiac tumors: experience at the University of Minnesota |journal=Thorac Cardiovasc Surg |volume=38 Suppl 2 |issue= |pages=183–91 |date=August 1990 |pmid=2237900 |doi=10.1055/s-2007-1014064 |url=}}</ref><ref name="pmid1434856">{{cite journal |vauthors=Tazelaar HD, Locke TJ, McGregor CG |title=Pathology of surgically excised primary cardiac tumors |journal=Mayo Clin. Proc. |volume=67 |issue=10 |pages=957–65 |date=October 1992 |pmid=1434856 |doi= |url=}}</ref><ref name="pmid14728061">{{cite journal |vauthors=Sarjeant JM, Butany J, Cusimano RJ |title=Cancer of the heart: epidemiology and management of primary tumors and metastases |journal=Am J Cardiovasc Drugs |volume=3 |issue=6 |pages=407–21 |date=2003 |pmid=14728061 |doi=10.2165/00129784-200303060-00004 |url=}}</ref><ref name="pmid7382545">{{cite journal |vauthors=St John Sutton MG, Mercier LA, Giuliani ER, Lie JT |title=Atrial myxomas: a review of clinical experience in 40 patients |journal=Mayo Clin. Proc. |volume=55 |issue=6 |pages=371–6 |date=June 1980 |pmid=7382545 |doi= |url=}}</ref><ref name="pmid11388092">{{cite journal |vauthors=Pinede L, Duhaut P, Loire R |title=Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases |journal=Medicine (Baltimore) |volume=80 |issue=3 |pages=159–72 |date=May 2001 |pmid=11388092 |doi= |url=}}</ref><ref name="pmid7477198">{{cite journal |vauthors=Reynen K |title=Cardiac myxomas |journal=N. Engl. J. Med. |volume=333 |issue=24 |pages=1610–7 |date=December 1995 |pmid=7477198 |doi=10.1056/NEJM199512143332407 |url=}}</ref><ref name="pmid24642215">{{cite journal |vauthors=Javed A, Zalawadiya S, Kovach J, Afonso L |title=Aortic valve myxoma at the extreme age: a review of literature |journal=BMJ Case Rep |volume=2014 |issue= |pages= |date=March 2014 |pmid=24642215 |pmc=3962858 |doi=10.1136/bcr-2013-202689 |url=}}</ref><ref name="pmid17698701">{{cite journal |vauthors=Lee VH, Connolly HM, Brown RD |title=Central nervous system manifestations of cardiac myxoma |journal=Arch. Neurol. |volume=64 |issue=8 |pages=1115–20 |date=August 2007 |pmid=17698701 |doi=10.1001/archneur.64.8.1115 |url=}}</ref><ref name="pmid4010501">{{cite journal |vauthors=Carney JA, Gordon H, Carpenter PC, Shenoy BV, Go VL |title=The complex of myxomas, spotty pigmentation, and endocrine overactivity |journal=Medicine (Baltimore) |volume=64 |issue=4 |pages=270–83 |date=July 1985 |pmid=4010501 |doi= |url=}}</ref><ref name="pmid10028128">{{cite journal |vauthors=McAllister HA, Hall RJ, Cooley DA |title=Tumors of the heart and pericardium |journal=Curr Probl Cardiol |volume=24 |issue=2 |pages=57–116 |date=February 1999 |pmid=10028128 |doi= |url=}}</ref><ref name="pmid9283541">{{cite journal |vauthors=Klarich KW, Enriquez-Sarano M, Gura GM, Edwards WD, Tajik AJ, Seward JB |title=Papillary fibroelastoma: echocardiographic characteristics for diagnosis and pathologic correlation |journal=J. Am. Coll. Cardiol. |volume=30 |issue=3 |pages=784–90 |date=September 1997 |pmid=9283541 |doi= |url=}}</ref><ref name="pmid26046736">{{cite journal |vauthors=Tamin SS, Maleszewski JJ, Scott CG, Khan SK, Edwards WD, Bruce CJ, Oh JK, Pellikka PA, Klarich KW |title=Prognostic and Bioepidemiologic Implications of Papillary Fibroelastomas |journal=J. Am. Coll. Cardiol. |volume=65 |issue=22 |pages=2420–9 |date=June 2015 |pmid=26046736 |doi=10.1016/j.jacc.2015.03.569 |url=}}</ref><ref name="pmid12947356">{{cite journal |vauthors=Gowda RM, Khan IA, Nair CK, Mehta NJ, Vasavada BC, Sacchi TJ |title=Cardiac papillary fibroelastoma: a comprehensive analysis of 725 cases |journal=Am. Heart J. |volume=146 |issue=3 |pages=404–10 |date=September 2003 |pmid=12947356 |doi=10.1016/S0002-8703(03)00249-7 |url=}}</ref><ref name="pmid9424072">{{cite journal |vauthors=Beghetti M, Gow RM, Haney I, Mawson J, Williams WG, Freedom RM |title=Pediatric primary benign cardiac tumors: a 15-year review |journal=Am. Heart J. |volume=134 |issue=6 |pages=1107–14 |date=December 1997 |pmid=9424072 |doi= |url=}}</ref><ref name="pmid2239731">{{cite journal |vauthors=Smythe JF, Dyck JD, Smallhorn JF, Freedom RM |title=Natural history of cardiac rhabdomyoma in infancy and childhood |journal=Am. J. Cardiol. |volume=66 |issue=17 |pages=1247–9 |date=November 1990 |pmid=2239731 |doi= |url=}}</ref><ref name="pmid7979700">{{cite journal |vauthors=Jacobs JP, Konstantakos AK, Holland FW, Herskowitz K, Ferrer PL, Perryman RA |title=Surgical treatment for cardiac rhabdomyomas in children |journal=Ann. Thorac. 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Thorac. Cardiovasc. Surg. |volume=12 |issue=2 |pages=89–100 |date=April 2000 |pmid=10807431 |doi= |url=}}</ref><ref name="pmid1008078">{{cite journal |vauthors=Petersen CD, Robinson WA, Kurnick JE |title=Involvement of the heart and pericardium in the malignant lymphomas |journal=Am. J. Med. Sci. |volume=272 |issue=2 |pages=161–5 |date=1976 |pmid=1008078 |doi= |url=}}</ref><ref name="pmid16595790">{{cite journal |vauthors=Ragland MM, Tak T |title=The role of echocardiography in diagnosing space-occupying lesions of the heart |journal=Clin Med Res |volume=4 |issue=1 |pages=22–32 |date=March 2006 |pmid=16595790 |pmc=1447535 |doi= |url=}}</ref><ref name="pmid20227122">{{cite journal |vauthors=Miguel CE, Bestetti RB |title=Primary cardiac lymphoma |journal=Int. J. 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Latest revision as of 16:33, 14 July 2022

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]

Overview

  • The cardiac tumors have some common features like fever, weight loss, and other constitutional symptoms. Each tumor has its peculiar characteristics that sets it apart from other tumors.

Differenting Cardiac Tumors from Other Diseases

Primary Cardiac Tumors
Benign Malignant
Myxoma Rhabdomyosarcoma
Rhabdomyoma Angiosarcoma
Fibroelastoma Fibrosarcoma
Cardiac Lipoma Lymphoma
Cardiac Hemangioma
Cardiac Fibroma
Atrioventricular tumors
Paragangliomas

Differential Diagnosis of Cardiac Mass

Cardiac tumors present as a cardiac mass on imaging. The following are the differentials of cardiac mass:[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48]

Site of Tumor Malignant Potential Type of Tumor Tissue of Origin Age of Presentation Location Morphology Signs and Symptoms MRI Findings
Systemic Manifestations Cardiac Manifestations Embolic Manifestations
Primary Cardiac Tumor Primary Benign Myxoma
  • Between third to sixth decade of life
  • 1-15 cm in diameter
  • Pedunculated
  • Polypoid
  • Smooth and lobulated
  • Villous and pappillary appearance associated with embolization
Rhabdomyoma
  • Striated Muscle
  • 1-3 cm in size
  • Yellow-gray color
  • Firm
  • Circumscribed lobulated
  • Majority multiple if associated with tuberous sclerosis (of those with no association, 50% are single)
  • Multiple masses isointense to muscle tissue on T1 images
  • Hyperintense on T2 images
Fibroma
  • Children (1/3rd in infants)
  • Solitary
  • Solitary mass
  • Low intensity on T2 weighted image
Fibroelastoma
  • < 1 cm in diameter
  • Solitary
  • Papillary
  • Flower-like appearance with multiple attachments to valve
  • Short pedicle
  • T1 and T2 weighted images show uniform intermediate signal intensity similar to myocardium
  • Homogeneous late gadolinium contrast enhancement
Hemangioma
  • < 1 year to 70 years
  • < 2 % of primary cardiac tumors
  • Polypoid
  • Encapsulated
  • Intermediate density on T1 images
  • Hypointense on T2 images
  • Multicystic enhancing lesion
  • Involvement of epicardium or pericardium
Lipoma
  • Between fourth to sixth decade of life
  • Epicardial or intramural lesion
  • High intensity on T1 weighted image
  • Drop out on fat saturation images
Paraganglioma
  • Average age of presentation is 11-13 years
  • 3-8 cm
  • Well-defined
  • Broad base
  • Encapsulated
  • Heterogeneous
  • Hypervascular
Atrioventricular Node Tumor
  • Average age of diagnosis is 38 years
  • Female to male ratio 3:1
  • Hypointense cardiac mass on standard imaging
  • Hyperintensity on late gadolinium enhancement (LGE) images with heterogeneous contrast enhancement
Lipomatous hypertrophy of the interatrial septum
  • > 60 years
-
Primary Malignant Fibrosarcoma
  • 20 to 80 years
  • Sessile or pedunculated protruding masses in ventricular cavities
  • Soft
  • Lobulated
  • Gelatinous
  • Heterogenous or isointense to myocardium on T1 weighted images
Angiosarcoma
  • 30 to 50 years
  • Arterial phase enhancement
Rhabdomyosarcoma
  • Most common primary sarcoma of children
  • Average age of presentation is 20 years
  • Multiple
  • Three types:
    • Embryonic
    • Pleomorphic
    • Alveolar
  • Intermediate-to-hypointensity compared with muscle on T1 images
  • Hyperintense on T2-weighted imaging with heterogeneous contrast enhancement
Lymphoma
  • 10 to 90 years
  • Males > females
  • Right sided mostly
  • Majority solitary (1/3rd multiple)
  • Hypointense on T1-weighted images and hyperintense on T2-weighted images
Secondary Cardiac Tumor Metastastatic Malignant Metastasis
  • Any age
  • Multiple

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