Cardiac tumors stand for a heterogeneous group, potentially involving any type of of the love structures.
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Secondary malignancies (metastatic) space the many frequent, with a 20 – 40 times higher incidence than main tumors. Main cardiac tumors have actually an incidence the 0.02% in autopsy series, seventy five percent that them gift benign<1>. The frequency and type of cardiac tumors varies amongst age groups and also are various in adults compared to children<2>.
Depending top top location and morphology, cardiac tumors can develop four types of clinical manifestations:Systemic – constitutional (fever, arthralgias, weight loss, fatigue) and also paraneoplastic syndromes (primary cardiac tumors).Embolic – pulmonary and/or systemic by tumor/thrombo emboli.Cardiac – mass impact interfering v myocardial function, blood flow, electrical impulse formation and also conduction, pericardial liquid dynamics.Secondary to metastatic an illness of a main malignant cardiac tumor – manifestations relying on site that metastasis<3>.
Role the echocardiography (transthoracic and also transesophageal) in the work-up of cardiac tumors:Diagnosis - usually first line imaging tool. Based upon location, appearance and extension and also correlated with the clinical findings deserve to discriminate in between primary - secondary and light - malignant.Treatment – along with complementary imaging modalities (CT, CMR, PET) offers information ~ above extension and resecability, and also plays a an important role in the follow up process.Newer methods like comparison echocardiography and real – time three dimensional echocardiography have the right to increase diagnostic accuracy by giving information ~ above tumor blood supply, composition and also relationship to nearby structures<4><5>.
Primary cardiac tumorsBenign Cardiac tumorsMyxoma
Figure 1.3D Transesophageal echocardiography mirroring a left atrial myxoma generally inserted in ~ the level the fosa ovalis and also protruding into the left ventricular inflow in diastole.
Lipomasare the 2nd most common benign cardiac tumors (10-20%). They stand for encapsulated fatty accumulations, space variable in size and also usually asymptomatic. Sometimes they may reason symptoms concerned compression, arrhythmias and conduction abnormalities<2>.Location – everywhere in the heart, most commonly in the left ventricle, appropriate atrium, and atrial septum. Lock arise most frequently in the subepicardium and also subendocardium, but intamyocardial lipomas have also been described. Subepicardial lipomas often prosper into the pericardial an are resulting in effusions and also subendocardial lipomas could protrude in the cardiac chambers, interfering through blood flow.On echocardiography castle present as well demarcated, homogeneous, large based masses (not diagnostic). Your appearance varies with location: in the pericardial room they arise indigenous the epicardium and are hypoechogenic, if intracavitary lipomas are hyperechogenic<1><2>.Cardiac CT and MRI room the ideal imaging devices for diagnosing cardiac lipomas together they determine fat with high specificity.Lipomas have actually the propensity to grow and periodic echocardiography must be performed. These tumors have to be operation excised when symptomatic<4>.
Lipomatous hypertrophy that the atrial septumis a benign cardiac mass result from fat infiltration that the atrial septum. Its described incidence ~ above echocardiographic research studies is 8% and, typically, is associated with enhancing age and also obesity.On echocardiography, the lipomatous hypertrophy the the atrial septum has actually a characteristic appearance with massive, hyperechogenic, thickening that the atrial septum the spares the fossa ovalis, acquisition a “dumbbell” or “hourglass” shape.Differentiation between this light lesion and also other cardiac tumors including the atrial septum, an especially malignant, is an essential as it might avoid unnecessary surgery<7>.Papillary fibroelastoma
Figure 2.Transesophageal echocardiography showing a solitary mitral valve fibroelastoma.
Figure 3.3D Transesophageal echocardiography showing two fibroelastomas entailing the aortic (arrow) and mitral (asterix) valves. Keep in mind the unusually huge mitral fibroelastoma originating in the posterior leaflet and also extending right into the subvalvular apparatus.
Figure 4.3D Transgastric check out of the appropriate chambers reflecting a giant sarcoma that obliterates the ideal ventricular inflow and infiltrates the tricuspid valve. Keep in mind the presence of hypoechogenic locations within the fixed (asterix) compatible with intratumoral necrosis. RA, ideal atrium; RVOT, best ventricular outflow tract.
AngiosarcomaAngiosarcomas room the most typical histological subtype, typically affecting middle-aged men. This tumors have a predilection because that the appropriate chambers, particularly for the appropriate atrium.Echocardiography shows, a large, large based mass close to the worse vena cava, prolonging intracavitary and also into the pericardium, sometimes invading the caval veins or tricuspid valve<2><5>.
RhabdomyosarcomaRhabdomyosarcomas stand for the most regular cardiac malignancy in infants and children.Rhabdomyosarcomas may take place in any type of cardiac chamber and also in 60% of instances are multiple. Likewise to angiosarcomas, this tumors prosper rapidly and are invasive, often extending to the pericardium prior to diagnosis<3>.
Other cardiac sarcomasOther nonvascular sarcomas, consisting of fibrosarcoma, liposarcoma, leiomyosarcoma, osteosarcoma, myxosarcoma, synovial sarcomas and undifferentiated sarcoma occur incredibly rare as major malignancies that the heart. They normally arise in the left atrium and likewise to angio- and rhabdomyosarcomas, are very invasive and aggressive.LymphomaPrimary cardiac lymphomas are very rare, representing 5% of major cardiac malignancies. They have increase ubiquity in immunocompromised patients.They are defined as non-Hodgkin’s lymphoma located initially only in the heart or pericardium. Cardiac joining in lymphomas is usually second and occurs by dissemination.Primary cardiac lymphomas involve an ext often the best side of the heart and usually associate through pericardial effusion. Prognosis is negative with much less than 1 month survival without treatment and up to 5 years after radio- and also chemotherapy<1><5>.Pericardial mesotheliomaPrimary malignant pericardial mesothelioma is extremely rare and unlike pleural and peritoneal mesotheliomas has no identify correlation with exposure to asbestos.Echocardiographic findings space pericardial effusion, pericardial thickening or constrictive physiology. Invasion of other cardiac frameworks is rarely seen.It tote a negative prognosis with tiny benefit indigenous radio and also chemo-therapy.
Secondary cardiac tumorsExtension to the heart is excellent by: haematogenous, lymphatic, direct or venous spread.Except for melanoma (very rare) that metastasis preferentially to the heart, cardiac metastasis are found in lung, breast, ovarian, kidney, leukemia, lymphoma, esophageal cancer patient in widespread dissemination stages.Echocardiography should be performed in all patients with a history of malignancy and cardiac symptoms.Pelvic leiomyoma (benign), renal cell carcinoma, hepatoma and uterine leiomyosarcoma (malignant) can prolong to the ideal cavities v inferior vena cava. This is best visualised in the subcostal view.Cardiac metastases room predominantly situated in the pericardium, with pericardial effusion being the most frequent finding.Chemotherapy and tumor resection may alleviate symptoms and prolong survival<1><4>.
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