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{{Cardiac tumors}}
{{Cardiac tumors}}
{{CMG}}; {{AE}} {{Dj}}
==Overview==
Biopsy is required for definitive diagnosis, echocardiogram is a preliminary diagnosing tool for most cardiac tumors. Certain cardiac tumors release inflammatory cytokines which can lead to increased blood inflammatory markers like ESR, CRP.


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==Laboratory Findings==
 
===Blood Investigations===
*Some patients with cardiac tumors may have [[anemia]], less commonly [[thrombocytopenia]], increases in [[sedimentation rate]], serum [[C-reactive protein]] level, or [[globulin]] level. These are nonspecific diagnostic anomalies.<ref name="pmid33040219">{{cite journal| author=Bussani R, Castrichini M, Restivo L, Fabris E, Porcari A, Ferro F | display-authors=etal| title=Cardiac Tumors: Diagnosis, Prognosis, and Treatment. | journal=Curr Cardiol Rep | year= 2020 | volume= 22 | issue= 12 | pages= 169 | pmid=33040219 | doi=10.1007/s11886-020-01420-z | pmc=7547967 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33040219  }} </ref><ref name="pmidhttps://pubmed.gov/11388092">{{cite journal| author=Pinede L, Duhaut P, Loire R| title=Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases. | journal=Medicine (Baltimore) | year= 2001 | volume= 80 | issue= 3 | pages= 159-72 | pmid=https://pubmed.gov/11388092 | doi=10.1097/00005792-200105000-00002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11388092  }} </ref>
*[[Antimyolemmal antibodies]] could also be elevated.  Antimyolemmal antibodies are significantly more prevalent in chronic [[pericardial effusion]], [[perimyocarditis]], and [[dilated cardiomyopathy]] patients than healthy controls.<ref name="pmid26941472">{{cite journal| author=Karatolios K, Pankuweit S, Richter A, Ruppert V, Maisch B| title=Anticardiac Antibodies in Patients with Chronic Pericardial Effusion. | journal=Dis Markers | year= 2016 | volume= 2016 | issue=  | pages= 9262741 | pmid=26941472 | doi=10.1155/2016/9262741 | pmc=4749782 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26941472  }} </ref>
*[[Antiendothelial antibodies]] of the IgG type are detected in 86 percent of [[atrial myxoma]] patients. [[Endothelial cells]] are activated by Antiendothelial antibodies, leading to enhanced leukocyte adhesion, clotting activation, and vessel thrombosis.<ref name="pmid16569688">{{cite journal| author=Belizna C, Duijvestijn A, Hamidou M, Tervaert JW| title=Antiendothelial cell antibodies in vasculitis and connective tissue disease. | journal=Ann Rheum Dis | year= 2006 | volume= 65 | issue= 12 | pages= 1545-50 | pmid=16569688 | doi=10.1136/ard.2005.035295 | pmc=1798473 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16569688 }} </ref><ref name="pmid26941472">{{cite journal| author=Karatolios K, Pankuweit S, Richter A, Ruppert V, Maisch B| title=Anticardiac Antibodies in Patients with Chronic Pericardial Effusion. | journal=Dis Markers | year= 2016 | volume= 2016 | issue=  | pages= 9262741 | pmid=26941472 | doi=10.1155/2016/9262741 | pmc=4749782 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26941472  }} </ref>
 
===Imaging===
*The '''CXR''' can detect cardiomegaly. A localized tumor prominence may or may not be present.
*On '''echocardiography''', a massive, noncontractile, firm lump may be observed in the atrial or ventricular walls. It is more useful in diagnosing myxomas as compared to sarcomas.<ref name="pmid12797518">{{cite journal| author=Gilkeson RC, Chiles C| title=MR evaluation of cardiac and pericardial malignancy. | journal=Magn Reson Imaging Clin N Am | year= 2003 | volume= 11 | issue= 1 | pages= 173-86, viii | pmid=12797518 | doi=10.1016/s1064-9689(02)00047-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12797518  }} </ref>
*'''Doppler ultrasonography''' measures of velocities can be used to calculate chamber pressures.<ref name="pmid10555666">{{cite journal| author=Araoz PA, Eklund HE, Welch TJ, Breen JF| title=CT and MR imaging of primary cardiac malignancies. | journal=Radiographics | year= 1999 | volume= 19 | issue= 6 | pages= 1421-34 | pmid=10555666 | doi=10.1148/radiographics.19.6.g99no031421 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10555666 }} </ref>
*'''Transesophageal echocardiography''' (TEE) is appropriate for evaluating malignancies anticipated to include the atria, interatrial septum, superior vena cava, atrioventricular valves, and, to a minor degree, the ventricles.<ref name="pmid12797518">{{cite journal| author=Gilkeson RC, Chiles C| title=MR evaluation of cardiac and pericardial malignancy. | journal=Magn Reson Imaging Clin N Am | year= 2003 | volume= 11 | issue= 1 | pages= 173-86, viii | pmid=12797518 | doi=10.1016/s1064-9689(02)00047-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12797518 }} </ref>
*'''CT and Cardiac MRI'''(CMR)are helpful for resectability evaluation.<ref name="pmid12797518">{{cite journal| author=Gilkeson RC, Chiles C| title=MR evaluation of cardiac and pericardial malignancy. | journal=Magn Reson Imaging Clin N Am | year= 2003 | volume= 11 | issue= 1 | pages= 173-86, viii | pmid=12797518 | doi=10.1016/s1064-9689(02)00047-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12797518  }} </ref>
*'''PET''' can be utilized to detect cardiovascular spread in patients with metastatic malignancies and enables surgical treatment.<ref name="pmid16632427">{{cite journal| author=García JR, Simo M, Huguet M, Ysamat M, Lomeña F| title=Usefulness of 18-fluorodeoxyglucose positron emission tomography in the evaluation of tumor cardiac thrombus from renal cell carcinoma. | journal=Clin Transl Oncol | year= 2006 | volume= 8 | issue= 2 | pages= 124-8 | pmid=16632427 | doi=10.1007/s12094-006-0169-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16632427  }} </ref>
**Imaging tests individually cannot determine if a heart tumor is benign or malignant; histologic assessment is required for a definite diagnosis.
 
===Biopsy===
*Biopsy provides the definitive diagnosis and can be performed either as a:
*Minimally invasive techniques such as
**[[cytologic assessment]] of pericardial/pleural fluids,
**echo-guided percutaneous cardiac biopsy, and
**echo-guided transvenous cardiac biopsy can be used to diagnose tissue.
*Or, [[mediastinoscopy]] or [[thoracotomy]] for more invasive tumor biopsies for a '''definitive diagnosis'''.<ref name="pmid22447042">{{cite journal| author=Lamba G, Frishman WH| title=Cardiac and pericardial tumors. | journal=Cardiol Rev | year= 2012 | volume= 20 | issue= 5 | pages= 237-52 | pmid=22447042 | doi=10.1097/CRD.0b013e31825603e7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22447042 }} </ref>
*The false-negative rate of Minimally Invasive techniques can be substantially high.<ref name="pmid22447042">{{cite journal| author=Lamba G, Frishman WH| title=Cardiac and pericardial tumors. | journal=Cardiol Rev | year= 2012 | volume= 20 | issue= 5 | pages= 237-52 | pmid=22447042 | doi=10.1097/CRD.0b013e31825603e7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22447042  }} </ref>


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Latest revision as of 20:19, 4 July 2022

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Template:Dj

Overview

Biopsy is required for definitive diagnosis, echocardiogram is a preliminary diagnosing tool for most cardiac tumors. Certain cardiac tumors release inflammatory cytokines which can lead to increased blood inflammatory markers like ESR, CRP.

Laboratory Findings

Blood Investigations

Imaging

  • The CXR can detect cardiomegaly. A localized tumor prominence may or may not be present.
  • On echocardiography, a massive, noncontractile, firm lump may be observed in the atrial or ventricular walls. It is more useful in diagnosing myxomas as compared to sarcomas.[5]
  • Doppler ultrasonography measures of velocities can be used to calculate chamber pressures.[6]
  • Transesophageal echocardiography (TEE) is appropriate for evaluating malignancies anticipated to include the atria, interatrial septum, superior vena cava, atrioventricular valves, and, to a minor degree, the ventricles.[5]
  • CT and Cardiac MRI(CMR)are helpful for resectability evaluation.[5]
  • PET can be utilized to detect cardiovascular spread in patients with metastatic malignancies and enables surgical treatment.[7]
    • Imaging tests individually cannot determine if a heart tumor is benign or malignant; histologic assessment is required for a definite diagnosis.

Biopsy

  • Biopsy provides the definitive diagnosis and can be performed either as a:
  • Minimally invasive techniques such as
    • cytologic assessment of pericardial/pleural fluids,
    • echo-guided percutaneous cardiac biopsy, and
    • echo-guided transvenous cardiac biopsy can be used to diagnose tissue.
  • Or, mediastinoscopy or thoracotomy for more invasive tumor biopsies for a definitive diagnosis.[8]
  • The false-negative rate of Minimally Invasive techniques can be substantially high.[8]

References

  1. Bussani R, Castrichini M, Restivo L, Fabris E, Porcari A, Ferro F; et al. (2020). "Cardiac Tumors: Diagnosis, Prognosis, and Treatment". Curr Cardiol Rep. 22 (12): 169. doi:10.1007/s11886-020-01420-z. PMC 7547967 Check |pmc= value (help). PMID 33040219 Check |pmid= value (help).
  2. Pinede L, Duhaut P, Loire R (2001). "Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases". Medicine (Baltimore). 80 (3): 159–72. doi:10.1097/00005792-200105000-00002. PMID https://pubmed.gov/11388092 Check |pmid= value (help).
  3. 3.0 3.1 Karatolios K, Pankuweit S, Richter A, Ruppert V, Maisch B (2016). "Anticardiac Antibodies in Patients with Chronic Pericardial Effusion". Dis Markers. 2016: 9262741. doi:10.1155/2016/9262741. PMC 4749782. PMID 26941472.
  4. Belizna C, Duijvestijn A, Hamidou M, Tervaert JW (2006). "Antiendothelial cell antibodies in vasculitis and connective tissue disease". Ann Rheum Dis. 65 (12): 1545–50. doi:10.1136/ard.2005.035295. PMC 1798473. PMID 16569688.
  5. 5.0 5.1 5.2 Gilkeson RC, Chiles C (2003). "MR evaluation of cardiac and pericardial malignancy". Magn Reson Imaging Clin N Am. 11 (1): 173–86, viii. doi:10.1016/s1064-9689(02)00047-8. PMID 12797518.
  6. Araoz PA, Eklund HE, Welch TJ, Breen JF (1999). "CT and MR imaging of primary cardiac malignancies". Radiographics. 19 (6): 1421–34. doi:10.1148/radiographics.19.6.g99no031421. PMID 10555666.
  7. García JR, Simo M, Huguet M, Ysamat M, Lomeña F (2006). "Usefulness of 18-fluorodeoxyglucose positron emission tomography in the evaluation of tumor cardiac thrombus from renal cell carcinoma". Clin Transl Oncol. 8 (2): 124–8. doi:10.1007/s12094-006-0169-7. PMID 16632427.
  8. 8.0 8.1 Lamba G, Frishman WH (2012). "Cardiac and pericardial tumors". Cardiol Rev. 20 (5): 237–52. doi:10.1097/CRD.0b013e31825603e7. PMID 22447042.

Template:WH Template:WS