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eMedicine Specialties > Radiology > Cardiac

Cardiac Tumors

Julia Gates, MD, Consulting Staff and Assistant Residency Program Director, Department of Radiology, Baystate Medical Center
George Hartnell, MB, Professor of Radiology, Tufts University School of Medicine, Director of Cardiovascular and Interventional Radiology, Department of Radiology, Baystate Medical Center

Updated: Jul 30, 2008

Introduction

Background

Cardiac tumors may be primary or secondary, may be related to the heart muscle or pericardium, or may be direct extensions of primary tumors or metastases from adjacent structures.

The presence of a cardiac tumor upon clinical examination and electrocardiography was first documented in 1934. Until that time, cardiac tumors were only identified postmortem. Angiography was first used to demonstrate an intracavitary cardiac tumor in 1951.1

In general, primary cardiac tumors are of mesothelial or epithelial origin. Tumors include myxoma (see Images 1-13), fibroma, lipoma (see Image 14), rhabdomyoma, plasma cell granuloma, sarcoma, lymphoma (see Image 15), thymoma, hemangiopericytoma (see Images 16-19), fibroelastoma (see Images 20-21), angioma, hemangioma, angiomyolipoma/hamartoma, lymphangioma, and mycosis fungoides.2,3,4,5,6,7,8,9,10,11,12

Related eMedicine topics:
Benign Cardiac Tumors
Cardiac Neoplasms, Primary

Related Medscape topics:
 Specialty Site Cardiology
Specialty Site Hematology-Oncology
CME Why CT Is a Mainstay Technology for Assessing Cardiac Disease
Cardiac Imaging Update, Part 1: MRI
Cardiac Imaging Update, Part 2: CTA

Endodermal tumors

Atrioventricular (AV) nodal tumors may contain neuroendocrine cells and, thus, may be of endodermal origin (as in polycystic tumor of the AV node or congenital endodermal heterotopia of the AV node).13,14 Cardiac paragangliomas have also been described.15,16 Patients with these tumors present with hypertension and elevated urinary catecholamine levels.17,18,19 These tumors tend to be left sided. Intracardiac pheochromocytomas also occur.20,21

Related eMedicine topics:
Pheochromocytoma

Myxomas
Myxomas are usually found in the left heart but can also occur in the right heart.22 Myxomas tend to be solitary and occur more often in women than in men. They are characteristically attached to the interatrial septum adjacent to the edge of the fossa ovalis (in approximately 85% of patients).23 Myxomas can invade the interatrial septum and the opposite atrium.24 Tumors may be pedunculated (see Images 10-13) or polypoid (see Images 3-5).23,25

Firm, oval masses are associated with dyspnea and show small vessels, tortuous vascularity, hemorrhage, and fibrosis. Soft papillary tumors are often associated with neurologic symptoms and brain infarcts.26 A study by Burke and Virmani showed that 41% of patients with myxomas have a surface thrombus and 41% have fibrosis.27 Patients with left-heart myxomas may present with mitral valve obstruction (see Images 1-2 and Images 10-13) or with findings suggestive of subacute bacterial endocarditis. Patients with right-heart myxomas may present with tricuspid valve disease, pulmonary embolism, or pulmonary hypertension.22,28,29

Related eMedicine topics:
 Atrial Myxoma

Sarcomas

Primary cardiac sarcomas encompass a broad spectrum of tumors, such as angiosarcoma (see Image 22), osteosarcoma, fibrosarcoma, malignant fibrous histiocytoma, leiomyosarcoma (see Images 23-24), myxosarcoma, synovial sarcoma, neurofibrosarcoma, lymphosarcoma, reticulum cell sarcoma, and undifferentiated sarcoma.11,30,31,32,33,34,35,36,37,38,39 Angiosarcomas tend to be located in the right heart (see Image 22), and osteosarcomas tend to be found in the left heart.38,39 Primary cardiac liposarcoma has also been reported, though it is extremely rare. It is part of the differential diagnosis for a mass with fat signal intensity on magnetic resonance imaging (MRI) scans. Most liposarcomas involving the heart either arise from the pericardium or are metastatic. All are rare.12,40,41

Patients with cardiac tumors range in age at presentation from 1 to 75 years and may present with symptoms secondary to distal metastases.38,42,43,44 Osteosarcomas tend to calcify and are usually found in the left atrium.39 Angiosarcomas are the most common malignant primary cardiac tumor, and leiomyosarcomas are the second most common. Leiomyosarcoma frequently invades the mitral valve and pulmonary veins, and it frequently involves the left atrium.39 Other common sarcomas include rhabdomyosarcomas and fibrosarcomas. Fibrosarcoma is often necrotic and favors the left atrium.38,42,43,44

Related eMedicine topic:
Cardiac Sarcoma

Metastatic disease

Metastatic disease may result from contiguous extension, lymphangitic spread, or hematogenous spread.45 Many of the metastatic cardiac tumors are bronchogenic carcinomas (see Images 25-26), breast carcinomas, lymphomas, leukemia, carcinoid tumors, or melanomas.11,46,47 Metastatic cervical carcinoma has also been reported.48 Metastases to the heart tend to involve the myocardium rather than the valves or the endocardium.23

Alternatively, contiguous extension of a tumor may originate from primary or metastatic disease. For example, metastases to the lung can invade the mediastinum by means of local extension, such as by a malignant thymoma.49,50 Liver cancer, such as hepatocellular carcinoma, can extend cephalad via the inferior vena cava into the heart.51

Other abdominal tumors can affect the heart. Extension of a tumor thrombus via the inferior vena cava into the right atrium is a well-recognized complication of advanced renal cell carcinoma (see Image 27); this can also occur with cervical carcinoma and renal angiomyolipomas.52,53,54 Benign uterine leiomyomatosis can affect the heart intravenously.55,56,57 Germ cell tumors (eg, testicular teratomas), embryonal cell carcinomas, and choriocarcinomas can metastasize to the heart58,59,60 ; thyroid metastases have been identified61 ; and musculoskeletal tumors, such as hemangiopericytomas, can metastasize and grow in the heart.62

Related eMedicine topics:
Metastatic Carcinoma
Hepatocellular Carcinoma

Pericardial tumors

Primary pericardial tumors include malignant spindle cell tumors, localized fibrous tumors (also called localized fibrous mesothelioma), pericardial cysts (see Images 28-30), liposarcomas, lipomas (see Image 31), and teratomas.39,63,64,65,66,67,68,69 Cardiac angiosarcomas tend to involve the pericardium secondarily and to produce hemorrhagic pericardial effusions.70

Pericardial mesotheliomas are frequently associated with asbestos exposure. Most specimens have identifiable asbestos fibers, particularly crocidolite and amosite fibers, as well as chrysotile (to a lesser extent).71 Not all mesotheliomas, however, arise in patients with a prior history of asbestos exposure.65,72 Lymphomas are frequently found in patients who are immunocompromised, and they frequently involve the pericardium.39 Liposarcomas are rare tumors that tend to be extracardiac and form large infiltrating masses.39

Cardiac valve tumors

Primary tumors of the cardiac valves and chordae are uncommon; however, when they do occur, they are usually fibroelastomas.73,74,75,76 Fibroelastomas are small tumors that may be an incidental finding at autopsy (see Images 20-21). They can be mistaken for heart valve vegetation. Lipomatous tumors of the heart valves also have been described.77

Cardiac tumors in childhood

Primary cardiac tumors that present in children include rhabdomyomas, intrapericardial teratomas, myxomas, fibromas, hemangiomas, mesotheliomas, multicystic hamartomas, epicardial lipomas, and rhabdomyosarcomas78,79 ; some tumors cannot be identified pathologically.80,81,82,83 Rhabdomyomas are the most common pediatric cardiac tumors. Most children with rhabdomyomas also have tuberous sclerosis,83 and these tumors can affect all 4 cardiac chambers.84 They frequently resolve spontaneously.42 Most primary pediatric tumors are diagnosed in the first year of life83 ; rhabdomyosarcoma is the most common pediatric malignant cardiac primary neoplasm. Compared with other primary cardiac sarcomas, rhabdomyosarcomas are more likely to involve the valves.39

Primary pediatric cardiac tumors present as murmurs and arrhythmias.83 Intrapericardial tumors can cause airway compression and subsequent dyspnea. In utero, fetuses can present with abnormal sonogram findings.85 These tumors can cause conduction abnormalities that can be evaluated by electrophysiologic testing and may be amenable to radiofrequency ablation.83

Related eMedicine topics:
 Cardiac Tumors: Pediatrics

Other cardiac masses

Some cardiac masses may not be tumors. Nonneoplasms or pseudotumors include thrombi or other variants of cardiac anatomy, such as a prominent pulmonary vein orifice (see Images 32-33), a right atrial Chiari network or crista terminalis (see Images 34-35), valvular vegetation, thrombi within a left ventricular aneurysm, lipomatous hypertrophy of the interatrial septum (see Image 36), rheumatoid nodules, pulmonary collapse, a ruptured chordae tendineae, intracardiac varices, tumors outside the heart and pericardium (which can resemble cardiac masses such as phrenic nerve tumors), and anatomic structures such as hiatal hernias (see Image 37).86,87,88,89,90,91  

Related eMedicine topics:
 Hiatal Hernia

Frequency

United States

The frequency of cardiac tumors is dependent on the frequency of autopsies performed in a specific region and the patient population being evaluated (see also Age).

  • Benign primary tumors are more frequent than malignant primary tumors. In 2 autopsy series, the cumulative prevalence of primary cardiac tumors was reported as 0.001-0.3%.92,93 Overall, myxomas account for approximately 30% of all primary cardiac neoplasms. Ninety percent of atrial myxomas occur on the left, and 90% are solitary.6 Angiosarcomas account for 33% of all malignant primary cardiac neoplasms, and myxomas account for approximately 50% of all benign primary cardiac neoplasms.6 Lipomas are the second most common benign cardiac tumors and account for approximately 10% of all cardiac neoplasms.94,95 The most common intracardiac mass is a thrombus.23
  • Secondary tumors are accepted to be more common than primary tumors by a factor of 20-30.
  • Metastatic tumors to the heart and pericardium are more common than primary neoplasms and occur in as many as 1.5% of patients with malignancies.23 The most common sources of metastatic tumors are as follows (in approximate order of frequency): bronchogenic carcinomas of the breast; lymphomas; leukemia; the esophagus; the uterus; melanomas; the stomach; sarcomas; germ cell tumors; and tumors of the mouth and/or tongue, the colon and/or rectum, the kidneys, the thyroid, the larynx, the urinary bladder, the hepatobiliary system, the prostate, the pancreas, and the ovaries.96

International

The incidence of cardiac tumors internationally is identical to that in the United States.

Mortality/Morbidity

  • Angiosarcomas have a high mortality rate. Most patients do not survive beyond 6 months from the time of diagnosis of this cardiac tumor.6,12
  • Mortality rates in patients with other malignant cardiac tumors are also high, especially in those with metastases, which tend to involve the heart late in the course of malignant disease.
  • Benign cardiac tumors can usually be resected and have a good prognosis.

 

Race

There is no known racial predisposition for cardiac tumors.

Sex

  • Cardiac myxomas tend to occur more often in women than in men.6
  • Cardiac lipomas have no sex predilection.23
  • Rhabdomyosarcomas and angiosarcomas are more common in males than in females.6
 

Age

Patients with primary cardiac sarcomas have presented at age 1-75 years.38 Cardiac lipomas occur in patients of any age.23

  • Pediatric tumors: Most primary pediatric tumors are diagnosed within the first year of life.83 Among pediatric patients, primary cardiac neoplasms include rhabdomyomas (78%), fibromas (11%), pericardial teratomas (2%), epicardial lipomas (2%), multicystic hamartomas (2%), and unspecified tumor types (5%).82 In children aged 15 years or younger, the most common benign primary cardiac tumors are rhabdomyomas (the most common benign primary tumor in patients <1 y of age, associated with tuberous sclerosis in 30-50% of patients), fibromas, hemangiomas, and teratomas. The most common malignant primary cardiac tumors in this age group are rhabdomyosarcoma fibrous histiocytoma, angiosarcoma, fibrosarcoma, and myxoid sarcoma.25,96
  • Adult tumors: Angiosarcomas tend to be found in patients aged 20-50 years.70,97  About 70% of myxomas occur in middle-aged patients, usually those aged 50-70 years.6,23 In adults, the most common benign primary cardiac tumors are (in approximate order of frequency) myxomas (>50%), fibromas, hemangiomas, granular cell tumors, lipomas, paragangliomas, hamartomas, histiocytomas, and hemangioendotheliomas. The most common malignant primary cardiac tumors in this population are (in approximate order of frequency) angiosarcomas, fibrous histiocytomas, leiomyosarcomas, osteosarcomas, fibrosarcomas, myxoid sarcomas, rhabdomyosarcomas, and liposarcomas.12,96

Presentation

Patients with left heart disease may present with mitral valve obstruction or apparent subacute bacterial endocarditis, and those with right heart disease may present with tricuspid valve disease, pulmonary embolism, or hypertension.22

Atrial myxomas can cause breathlessness, fever, weight loss, syncope, hemoptysis, peripheral emboli, and sudden death.6

Angiosarcomas frequently involve the right heart and result in right-sided heart failure. Cardiac tamponade secondary to bloody pericardial effusions or tamponade with pleuritic chest pain may also be present.6,23,70

Intrapericardial masses can cause dyspnea as a result of airway compression.68,81

Patients with cardiac fibromas may present with congestive heart failure, arrhythmias, sudden death, cyanosis, or chest pain; one third of patients may be asymptomatic.98,99

Chest pain, palpitations, and flushing may be present in cases of intracardiac pheochromocytomas.21 Catecholamine release can cause irregular heartbeats, which can be detected by the patient as palpitations. Blood pressure can rise with an increased pulse rate, resulting in more work for the heart.

Lipomatous hypertrophy of the interatrial septum is frequently found in people with obesity (see Image 36).6

Most children with rhabdomyomas also have tuberous sclerosis, which is associated with adenoma sebaceum, seizures, and mental retardation.

Preferred Examination

Initially, intracardiac tumors are best evaluated by using echocardiography. Differentiation of left atrial masses from thrombi may be best achieved by using transesophageal echocardiography. Because they provide a larger field of view, which affords a better opportunity to assess contiguous extracardiac involvement or the presence of metastatic disease, MRI, magnetic resonance angiography (MRA), and computed tomography (CT) are preferred over echocardiography for cases that are not as straightforward, or for cases in which acoustic access is restricted.100

Limitations of Techniques

Chest radiography may show the effects of intracardiac obstruction with features of pulmonary edema (see Images 1-2) but otherwise may contribute little. Echocardiography is easily accessible, but it is limited by restricted acoustic access. CT scanning is accurate but requires radiation and contrast material. In suitable patients, MRI has the fewest limitations, provided that the patient can remain motionless during the examination .

Differential Diagnoses

Chondrosarcoma
Pheochromocytoma
Leiomyoma, Uterus (Fibroid)
Renal Cell Carcinoma
Liposarcoma, Soft Tissue
Mesothelioma, Malignant
Osteosarcoma, Variants

Other Problems to Be Considered

Primary cardiac tumors

  • Myxoma, fibroma, lipoma, rhabdomyoma, plasma cell granuloma, sarcoma, lymphoma, thymoma, hemangiopericytoma, fibroelastoma, mycosis fungoides, hamartoma/angiomyolipoma, hemangioma, angioma, lymphangioma, and pheochromocytoma

Primary cardiac sarcomas

  • Angiosarcoma, osteosarcoma, fibrosarcoma, malignant fibrous histiocytoma, leiomyosarcoma, myxosarcoma, synovial sarcoma, neurofibrosarcoma, liposarcoma, lymphosarcoma, reticulum cell sarcoma, and undifferentiated sarcoma

Metastatic tumors

  • Bronchogenic carcinoma, breast carcinoma, lymphoma, leukemia, carcinoid tumor, melanoma, cervical carcinoma, and germ cell tumors

Primary pediatric cardiac tumors

  • Rhabdomyoma, intrapericardial teratoma, myxoma, fibroma, hemangioma, mesothelioma, multicystic hamartoma, epicardial lipoma, and rhabdomyosarcoma

Pericardial tumors

  • Malignant spindle cell tumor, localized fibrous tumor (also termed localized fibrous mesothelioma), pericardial cyst, direct extension of primary cardiac tumors, or lung cancer

Radiography

Findings

Plain radiography is not an effective method for screening for cardiac neoplasms or for evaluating the extent of a tumor.

  • Cardiac myxomas may be calcified; therefore, they may be visible on lateral chest radiographs.
  • Left atrial enlargement may be noted; this may result from mitral valve obstruction (see Images 1-2).
  • Diseases that expand the cardiac silhouette, either by bulk or by secondary effusion, may be suggestive of pericardial involvement.

Degree of Confidence

The degree of confidence is limited concerning cardiac tumors. Plain radiographic changes in cardiac tumors are nonspecific.

Computed Tomography

Findings

By virtue of its larger field of view, CT scanning is better than echocardiography for many situations in which mediastinal involvement or restricted acoustic access is suspected. Both the heart and contiguous structures can be assessed.

  • Cardiac function, as well as the effects of a tumor on cardiac function, can be evaluated using ECG-gated multiring detector spiral scanners or electron-beam scanners. Such functional imaging is on par with functional MRI.
  • These techniques can also be used to detect the motion of a pedunculated tumor, such as an atrial myxoma.
  • Tumors that calcify (eg, myxomas) can also be imaged by CT, with excellent depiction of calcific attenuating areas.
  • Tumor tissue tends to have an attenuation of approximately 40-100 HU.23 Cardiac or pericardial lipomas are easily identified by low attenuation (-100 HU) and look similar to the fat of the mediastinum (see Image 31).101
  • Angiosarcomas frequently appear as right atrial masses with accompanying hemopericardium (see Image 22).23,102

Degree of Confidence

The degree of confidence is high for detecting cardiac tumors on contrast-enhanced CT scanning. Tissue characterization is limited. ECG gating improves image quality and precision.

Magnetic Resonance Imaging

Findings

Both MRI and MRA are superior to echocardiography for detecting or excluding cardiac tumors, for finding the precise location of cardiac tumors (ie, paracardiac, mural, or intracavitary), for determining the extent of disease, for detecting the presence of effusions, and for detecting the presence of metastases.103 Other effects and complications associated with tumors are well demonstrated. Contrast-enhanced MRI may define the extent of the tumor, but it is limited for discerning benign from malignant disease. MRI has advantages over CT because intravenous contrast material is not required for imaging.102,104

  • Extracardiac disease and cardiac morphology are both well demonstrated.
  • Cardiac contractility can be evaluated.105
  • MRI may be better than CT at depicting tumor morphology via soft-tissue contrast resolution.23
  • The effects of the disease on cardiac function can be assessed by using MRI/MRA via cine and tagging techniques.
  • Contrast-enhanced MRI can be used to differentiate areas of slow flow from solid material (ie, thrombus or tumor).
  • Based on signal-intensity characteristics, an estimate of the tissue type may be possible. Fatty masses demonstrate high signal intensity on T1-weighted spin-echo images (see Image 14) and medium signal intensity on T2-weighted spin-echo images.
  • Lipomatous hypertrophy of the interatrial septum (LHIAS) (see Image 36) is a transformation of tissue rather than an actual neoplasm. LHIAS demonstrates high signal intensity on T1-weighted images and can extend to the free wall.
  • Myxomas tend to have low signal intensity on breath-hold cine images, and they are visually conspicuous against surrounding bright (hyperintense) blood (see Images 3-4, Image 8). Similarly, turbo short-tau inversion recovery images demonstrate a hyperintense tumor enveloped by hypointense blood within the atrium (see Image 7); however, myxomas have variable amounts of calcification and fibrous, myxomatous tissue (which is bright on T2-weighted images).7 Water-rich myxomatous tissue tends to have a signal intensity higher than that of normal myocardium on T2-weighted images.23
  • Angiosarcomas often have high signal intensity on T1-weighted images.39

Gadolinium-based contrast agents (gadopentetate dimeglumine [Magnevist], gadobenate dimeglumine [MultiHance], gadodiamide [Omniscan], gadoversetamide [OptiMARK], gadoteridol [ProHance]) have been linked to the development of nephrogenic systemic fibrosis (NSF) or nephrogenic fibrosing dermopathy (NFD). For more information, see the eMedicine topic Nephrogenic Fibrosing Dermopathy .

NSF/NFD has occurred in patients with moderate to end-stage renal disease, after being given a gadolinium-based contrast agent to enhance MRI or MRA scans. NSF/NFD is a debilitating and sometimes fatal disease. Characteristics include red or dark patches on the skin; burning, itching, swelling, hardening, and tightening of the skin; yellow spots on the whites of the eyes; joint stiffness with trouble moving or straightening the arms, hands, legs, or feet; pain deep in the hip bones or ribs; and muscle weakness. For more information, see the FDA Public Health Advisory or Medscape.

Degree of Confidence

MRI probably offers the most accurate noninvasive test for cardiac tumors in patients who can hold their breath. Prominence of the crista terminalis or Chiari network and juxtacardiac masses can be mistaken for tumors (see Images 32-37).

False Positives/Negatives

Regarding cardiac tumors, few false findings occur. Errors most frequently result from patient movement or interpreter inexperience (eg, misinterpretation of pseudotumors).

Ultrasonography

Findings

Unlike CT or MRI, echocardiography is somewhat operator dependent, and it has a more limited field of view. Areas behind the sternum, ribs, or lungs cannot be visualized adequately, and acoustic windows limit the structures imaged on any single plane or view. The benefit of echocardiography is its portability and ease of use for a first-peek approach to cardiac pathology.

In many patients, especially those with myxomas, echocardiography may be all that is required to make the diagnosis and stage the tumor. In patients with poor-quality transthoracic echocardiograms, transesophageal echocardiography usually provides better images, especially for masses in or adjacent to the left atrium (see Images 12-13).

  • The characteristic finding on M-mode and 2-dimensional (2D) echocardiography of left atrial myxomas (the most common primary cardiac tumor) is an echogenic mass in the left atrium during ventricular systole, which is seen prolapsing through the mitral valve during diastole (see Images 9-13).
  • The mass may be mobile or relatively sessile.
  • Myxomas may demonstrate variable echogenicity and can cause atrial enlargement.
  • Other tumors may invade the myocardium or project into the affected cavities (see Image 27). Often, pericardial effusion is associated with malignant tumors (see Image 15).
  • Prenatal ultrasonography can identify intracardiac masses and brain lesions of tuberous sclerosis and intrapericardial tumors, such as teratomas.85,80

 

Degree of Confidence

Ultrasonographic findings are accurate for identifying tumors inside cardiac chambers, provided that acoustic access is adequate. Ultrasonography is less helpful if acoustic access is poor or if tumors extend outside the heart or into the great vessels. Although it is more invasive, transesophageal echocardiography is best for imaging left atrial and left ventricular tumors.

False Positives/Negatives

Prominence of the crista terminalis or Chiari network juxtacardiac masses (eg, hiatal hernia) may create false findings (see Image 37).

Nuclear Imaging

Findings

Pheochromocytomas may be imaged by using metaiodobenzylguanidine (mIBG) uptake studies; otherwise, the use of nuclear medicine studies is limited.

Angiography

Findings

The need for angiography is limited. Tumor vascularity may be seen with selective angiography (see Image 19). Generally, angiography is only required if information concerning the coronary artery anatomy is required or if percutaneous intervention is planned.

Neovascularity of myxomas may be seen on selective angiography. 106, 107

Intervention

Benign cardiac tumors can usually be resected and have a good prognosis.

Lymphoma tends to be responsive to chemotherapy.39 Rhabdomyosarcomas may also be treated with chemotherapy. Pediatric rhabdomyomas are conservatively treated because many resolve spontaneously. Angiosarcomas have a poor prognosis and are not responsive to chemotherapy. Most patients die within 6 months of the diagnosis.6,12 In extreme cases, selective embolization or chemoembolization may help relieve the symptoms (see Image 19).

Outflow obstructions can be treated with stenting.108

Benign cysts can safely be drained under echocardiographic or CT guidance with a high expectation of success (see Images 28-30).

Multimedia

Posteroanterior (PA) chest radiograph shows pulmo...

Media file 1: Posteroanterior (PA) chest radiograph shows pulmonary venous congestion and prominence of the left atrial appendage in a patient with a left atrial myxoma obstructing the mitral valve.

Lateral chest radiograph shows prominence of the ...

Media file 2: Lateral chest radiograph shows prominence of the left atrium (arrow) in a patient with a left atrial myxoma obstructing the mitral valve (same patient as in Image 1).

Cine magnetic resonance angiogram (in early diast...

Media file 3: Cine magnetic resonance angiogram (in early diastole) shows low signal intensity in a sessile left atrial myxoma.

Cine magnetic resonance angiogram of a patient wi...

Media file 4: Cine magnetic resonance angiogram of a patient with a left atrial myxoma (in late diastole) shows only minor movement of the tumor during diastole with some loss of signal intensity (arrow), caused by flow dephasing resulting from turbulent flow around the tumor.

Gadolinium-enhanced turbo fast low-angle shot (FL...

Media file 5: Gadolinium-enhanced turbo fast low-angle shot (FLASH) MRI scan of a patient with a left atrial myxoma shows lack of enhancement of the tumor mass (arrow). This is not a uniform finding, as some myxomas show mild contrast enhancement that may allow for differentiation of a myxoma from a thrombus.

T1-weighted turbo spin-echo MRI scan shows interm...

Media file 6: T1-weighted turbo spin-echo MRI scan shows intermediate signal intensity in a left atrial myxoma (M) attached to the margin of the fossa ovalis (between the arrows). LA indicates the left atrium; RA, the right atrium; and RV, the right ventricle.

Turbo short-tau inversion recovery (STIR) MRI sca...

Media file 7: Turbo short-tau inversion recovery (STIR) MRI scan shows high signal intensity in a left atrial myxoma (M) attached to the margin of the fossa ovalis (same patient as in Image 6).

Cine magnetic resonance angiogram shows low signa...

Media file 8: Cine magnetic resonance angiogram shows low signal intensity in a left atrial myxoma (M) surrounded by high signal intensity in flowing blood (same patient as in Images 6-7). LA indicates the left atrium; RA, the right atrium; and RV, the right ventricle.

M-mode echocardiogram in a patient with a left at...

Media file 9: M-mode echocardiogram in a patient with a left atrial myxoma. Sweep from the left atrium to the mitral valve shows a change in the timing of tumor echoes from systole (in the left atrium) to diastole (through the mitral valve).

Apical 4-chamber 2-dimensional echocardiogram of ...

Media file 10: Apical 4-chamber 2-dimensional echocardiogram of a left atrial myxoma during ventricular systole shows the echogenic mass of the myxoma (M) in the left atrium. LA indicates the left atrium; LV, the left ventricle; and RA, the right atrium.

Apical 4-chamber 2-dimensional echocardiogram of ...

Media file 11: Apical 4-chamber 2-dimensional echocardiogram of a left atrial myxoma during ventricular diastole shows the echogenic mass of the myxoma (M) now prolapsing through the mitral valve orifice into the left ventricle (same patient as in Image 10). LA indicates the left atrium; LV, the left ventricle; and RA, the right atrium.

Transesophageal echocardiogam obtained during ear...

Media file 12: Transesophageal echocardiogam obtained during early diastole in a patient with a left atrial myxoma shows an echogenic tumor mass (M) projecting from the interatrial septum and partially obstructing the mitral valve. The arrows indicate the leaflets and LV indicates the left ventricle.

Transesophageal echocardiogram obtained at end-di...

Media file 13: Transesophageal echocardiogram obtained at end-diastole in a patient with a left atrial myxoma shows that the myxoma (M) has moved toward, but not through, the mitral valve orifice (same patient as in Image 12). LV indicates left ventricle.

Coronal turbo fast low-angle shot (FLASH) MRI sca...

Media file 14: Coronal turbo fast low-angle shot (FLASH) MRI scan of a patient with a right atrial lipoma shows a high-signal-intensity mass (L) in the lateral wall of the right atrium. High signal intensity on T1 imaging is strongly suggestive of fatty tissue and identifies this mass as a lipoma.

Axial T1-weighted spin-echo MRI scan of a patient...

Media file 15: Axial T1-weighted spin-echo MRI scan of a patient with a retrosternal lymphoma shows intermediate signal intensity in the retrosternal mass of lymphoma tissue (L) and an associated pericardial effusion (arrow).

Spin-echo MRI scan in a patient with hemangioperi...

Media file 16: Spin-echo MRI scan in a patient with hemangiopericytoma shows a large intermediate-signal-intensity retrocardiac mass (*) behind the left ventricle (LV). These signal-intensity characteristics can indicate any of a large number of tissue types. RA indicates the right atrium.

Pregadolinium gradient-echo MRI scan of a patient...

Media file 17: Pregadolinium gradient-echo MRI scan of a patient with hemangiopericytoma shows low signal intensity in the tumor (*). This is the same patient as in Image 16.

Gadolinium-enhanced gradient-echo MRI scan (taken...

Media file 18: Gadolinium-enhanced gradient-echo MRI scan (taken 160 seconds after Image 17) of a patient with a hemangiopericytoma shows slow peripheral enhancement of the tumor mass (*); this indicates only moderate vascularity (same patient as in Image 17).

Digital subtraction angiogram during embolization...

Media file 19: Digital subtraction angiogram during embolization of a hemangiopericytoma shows selective injection into an internal mammary artery branch. Only mild vascularity (arrows) is noted, as predicted by the contrast-enhancement pattern on the MRIs (same patient as in Images 16-18).

Cine short-axis magnetic resonance angiogram in a...

Media file 20: Cine short-axis magnetic resonance angiogram in a patient with a fibroelastoma shows a low-signal-intensity mass (black arrow) projecting from the interventricular septum and projecting into the left ventricle. The moderator band (white arrow) is seen crossing the right ventricular cavity. The moderator band is a normal structure that can sometimes mimic an abnormal mass.

Turbo short-tau inversion recovery short-axis MRI...

Media file 21: Turbo short-tau inversion recovery short-axis MRI scan of a patient with a fibroelastoma shows a high-signal-intensity mass (arrow) projecting from the interventricular septum into the left ventricle.

Contrast-enhanced CT scan of a patient with an an...

Media file 22: Contrast-enhanced CT scan of a patient with an angiosarcoma shows a tumor mass invading the right side of the heart (T) with extension rising up from the inferior vena cava (arrow). A large right pleural effusion and a smaller left pleural effusion are noted.

Oblique 4-chamber turbo short-tau inversion recov...

Media file 23: Oblique 4-chamber turbo short-tau inversion recovery (STIR) MRI scan of a patient with a metastatic leiomyosarcoma shows an apical tumor mass (*) that is invading through the posterior wall of the left ventricle and is associated with a high-signal-intensity posterior pericardial effusion.

Oblique 4-chamber turbo spin-echo MRI scan shows ...

Media file 24: Oblique 4-chamber turbo spin-echo MRI scan shows an apical tumor mass (*) that has lower signal intensity than it does in Image 23. Note how this sequence provides less discrimination between the tumor, the normal myocardium, and the pericardial fluid.

Axial T1-weighted turbo spin-echo MRI scan of a p...

Media file 25: Axial T1-weighted turbo spin-echo MRI scan of a patient with a metastatic bronchogenic carcinoma shows a tumor invading the wall of the right atrium with a mass (arrow) in the area of the tricuspid valve.

Oblique 4-chamber turbo short-tau inversion recov...

Media file 26: Oblique 4-chamber turbo short-tau inversion recovery (STIR) MRI scan of a patient with metastatic bronchogenic carcinoma shows the tumor invading the wall of the right atrium and the interatrial septum (same patient as in Image 25). The mass is separate from, but is obstructing, the tricuspid valve (arrows).

Two-dimensional echocardiogram of a hypernephroma...

Media file 27: Two-dimensional echocardiogram of a hypernephroma invading the inferior vena cava, the right atrium, and the atrial septum. Echogenic material indicates tumor tissue invading the wall of the right atrium (T1) and growing from the inferior vena cava into the right atrial cavity (T2).

CT scan of a pericardial cyst. A well-defined api...

Media file 28: CT scan of a pericardial cyst. A well-defined apical mass (C) has the characteristic position and low attenuation of a pericardial cyst.

CT-guided pericardial cyst drainage. By using CT ...

Media file 29: CT-guided pericardial cyst drainage. By using CT guidance, a pigtail drainage catheter was inserted into the cyst. Approximately 500 mL of clear fluid was aspirated.

CT scan of a pericardial cyst. After drainage, n...

Media file 30: CT scan of a pericardial cyst. After drainage, no residual fluid is noted around the pigtail catheter (arrow).

CT scan of a pericardial lipoma. A large, low-att...

Media file 31: CT scan of a pericardial lipoma. A large, low-attenuating mass extends from the cardiac apex; this finding is characteristic of a lipoma.

Axial T1-weighted turbo spin-echo MRI scan of a p...

Media file 32: Axial T1-weighted turbo spin-echo MRI scan of a patient with a left atrial pseudomass shows expansion (arrow) of the pulmonary vein tissue as it enters the left atrium.

Axial cine magnetic resonance angiogram in a pati...

Media file 33: Axial cine magnetic resonance angiogram in a patient with a left atrial pseudomass shows loss of signal intensity caused by turbulent flow (arrows) around the region of the expansion of the pulmonary vein tissue entering the left atrium (shown in Image 32).

Oblique 4-chamber cine magnetic resonance angiogr...

Media file 34: Oblique 4-chamber cine magnetic resonance angiogram of a patient with a right atrial pseudomass shows a prominence (arrow) in the right atrium arising from the free wall of the right atrium. This is a prominent ridge resulting from incomplete resorption of the crista terminalis.

Axial T1-weighted turbo spin-echo MRI scan of a p...

Media file 35: Axial T1-weighted turbo spin-echo MRI scan of a patient with a right atrial pseudomass shows a high-signal-intensity prominence (arrow) in the right atrium arising from the free wall of the right atrium, the crista terminalis (same patient as in Image 34).

Axial ECG-gated spin-echo MRI scan shows high-sig...

Media file 36: Axial ECG-gated spin-echo MRI scan shows high-signal-intensity thickening (*) resulting from lipomatous hypertrophy of the interatrial septum.

Coronal turbo spin-echo MRI scan of a patient wit...

Media file 37: Coronal turbo spin-echo MRI scan of a patient with a hiatal hernia. Echocardiography suggested a possible tumor mass compressing the posterior part of the heart. On MRI, the rugal folds and fluid contents of the stomach in the hiatal hernia (HH) are clearly demonstrated.

References

  1. Majano-Lainez RA. Cardiac tumors: a current clinical and pathological perspective. Crit Rev Oncog. 1997;8(4):293-303. [Medline].

  2. Waller DA, Ettles DF, Saunders NR, Williams G. Recurrent cardiac myxoma: the surgical implications of two distinct groups of patients. Thorac Cardiovasc Surg. Aug 1989;37(4):226-30. [Medline].

  3. Inoue H, Shimokawa S, Iguro Y, et al. Involvement of the right atrium by malignant lymphoma as a cause of right cardiac failure: report of a case. Surg Today. 2000;30(4):394-6. [Medline].

  4. Gosalbez F, Miralles T, Cofino J, et al. Primary lymphomas of the heart in immunocompetent patients. Presentation of two cases with one 12 year survival. Analysis of surgical implications. Minerva Cardioangiol. Mar 1999;47(3):75-9. [Medline].

  5. Nakamura Y, Nishiya Y, Kawada M, et al. Primary hemangiopericytoma of the heart associated with pseudoaneurysm of the pulmonary artery--a case report. Angiology. Oct 1987;38(10):788-92. [Medline].

  6. Shapiro LM. Cardiac tumours: diagnosis and management. Heart. Feb 2001;85(2):218-22. [Medline].

  7. Kemp JL, Kessler RM, Raizada V, Williamson MR. Case report. MR and CT appearance of cardiac hemangioma. J Comput Assist Tomogr. May-Jun 1996;20(3):482-3. [Medline].

  8. Grenadier E, Margulis T, Palant A, et al. Huge cavernous hemangioma of the heart: a completely evaluated case report and review of the literature. Am Heart J. Feb 1989;117(2):479-81. [Medline].

  9. Tsai CC, Chou CY, Han SJ, et al. Cardiac angiomyolipoma: radiologic and pathologic correlation. J Formos Med Assoc. Aug 1997;96(8):653-6. [Medline].

  10. Pasaoglu I, Dogan R, Ozme S, et al. Cardiac lymphangioma. Am Heart J. Jun 1991;121(6 Pt 1):1821-4. [Medline].

  11. Roberts WC, Glancy DL, DeVita VT Jr. Heart in malignant lymphoma (Hodgkin's disease, lymphosarcoma, reticulum cell sarcoma and mycosis fungoides). A study of 196 autopsy cases. Am J Cardiol. Jul 1968;22(1):85-107. [Medline].

  12. Simpson L, Kumar SK, Okuno SH, Schaff HV, Porrata LF, Buckner JC, et al. Malignant primary cardiac tumors: review of a single institution experience. Cancer. Jun 1 2008;112(11):2440-6. [Medline].

  13. Fine G, Raju U. Congenital polycystic tumor of the atrioventricular node (endodermal heterotopia, mesothelioma): a histogenetic appraisal with evidence for its endodermal origin. Hum Pathol. Aug 1987;18(8):791-5. [Medline].

  14. Linder J, Shelburne JD, Sorge JP, et al. Congenital endodermal heterotopia of the atrioventricular node: evidence for the endodermal origin of so-called mesotheliomas of the atrioventricular node. Hum Pathol. Nov 1984;15(11):1093-8. [Medline].

  15. Kennelly R, Aziz R, Toner M, Young V. Right atrial paraganglioma: an unusual primary cardiac tumour. Eur J Cardiothorac Surg. Jun 2008;33(6):1150-2. [Medline].

  16. Maxey TS, Grow P, Morris CD, Patton KT, Guyton RA. Biatrial primary cardiac paraganglioma: a rare finding. Cardiovasc Pathol. May-Jun 2007;16(3):179-82. [Medline].

  17. Johnson TL, Shapiro B, Beierwaltes WH, et al. Cardiac paragangliomas. A clinicopathologic and immunohistochemical study of four cases. Am J Surg Pathol. Nov 1985;9(11):827-34. [Medline].

  18. Conti VR, Saydjari R, Amparo EG. Paraganglioma of the heart. The value of magnetic resonance imaging in the preoperative evaluation. Chest. Oct 1986;90(4):604-6. [Medline].

  19. Cane ME, Berrizbeitia LD, Yang SS, et al. Paraganglioma of the interatrial septum. Ann Thorac Surg. Jun 1996;61(6):1845-7. [Medline].

  20. Chang CH, Lin PJ, Chang JP, et al. Intrapericardial pheochromocytoma. Ann Thorac Surg. Apr 1991;51(4):661-3. [Medline].

  21. Fitzgerald PJ, Ports TA, Cheitlin MD, et al. Intracardiac pheochromocytoma with dual coronary blood supply: case report and literature review. Cardiovasc Surg. Oct 1995;3(5):557-61. [Medline].

  22. Symbas PN, Hatcher CR Jr, Gravanis MB. Myxoma of the heart: clinical and experimental observations. Ann Surg. May 1976;183(5):470-5. [Medline].

  23. Schvartzman PR, White RD. Imaging of cardiac and paracardiac masses. J Thorac Imaging. Oct 2000;15(4):265-73. [Medline].

  24. Peachell JL, Mullen JC, Bentley MJ, Taylor DA. Biatrial myxoma: a rare cardiac tumor. Ann Thorac Surg. Jun 1998;65(6):1768-9. [Medline].

  25. Yu K, Liu Y, Wang H, Hu S, Long C. Epidemiological and pathological characteristics of cardiac tumors: a clinical study of 242 cases. Interact Cardiovasc Thorac Surg. Oct 2007;6(5):636-9. [Medline].

  26. Shimono T, Makino S, Kanamori Y, et al. Left atrial myxomas. Using gross anatomic tumor types to determine clinical features and coronary angiographic findings. Chest. Mar 1995;107(3):674-9. [Medline].

  27. Burke AP, Virmani R. Cardiac myxoma. A clinicopathologic study. Am J Clin Pathol. Dec 1993;100(6):671-80. [Medline].

  28. Seemann MD, Brenner P. Demonstration of spiral CT scans and reconstructions of a right atrial myxoma with bilateral pulmonary tumor emboli and a coincidental benign mediastinal thymoma. Eur J Med Res. Sep 20 1996;1(11):515-9. [Medline].

  29. Gaumann A, Strubel G, Bode-Lesniewska B, Schmidtmann I, Kriegsmann J, Kirkpatrick CJ. The role of tumor vascularisation in benign and malignant cardiovascular neoplasms: A comparison of cardiac myxoma and sarcomas of the pulmonary artery. Oncol Rep. Aug 2008;20(2):309-18. [Medline].

  30. Ohtahara A, Hattori K, Fukuki M, et al. Cardiac angiosarcoma. Intern Med. Oct 1996;35(10):795-8. [Medline].

  31. Dan S, Hodge AJ. Osteogenic sarcoma of the left atrium. Ann Thorac Surg. Jun 1997;63(6):1766-8. [Medline].

  32. Lim YT, Lee CN, Chia BL. Images in cardiology. Fibrosarcoma of the heart. Heart. Oct 1998;80(4):369. [Medline].

  33. Seal EC, Rutter HR, Horrigan MC, Britton MG. Left atrial tumour mimicking pulmonary embolism. Respir Med. Oct 1997;91(9):562-4. [Medline].

  34. Fang CY, Fu M, Chang JP, et al. Malignant fibrous histiocytoma of the left ventricle: a case report. Changgeng Yi Xue Za Zhi. Jun 1996;19(2):187-90. [Medline].

  35. Lo FL, Chou YH, Tiu CM, et al. Primary cardiac leiomyosarcoma: imaging with 2-D echocardiography, electron beam CT and 1.5-Tesla MR. Eur J Radiol. Mar 1998;27(1):72-6. [Medline].

  36. Davis GK, Jones EL, Bonser RS, Roberts DH. Coronary arteriographic and pathological findings in a case of primary leiomyosarcoma of the heart. Int J Cardiol. May 23 1997;59(3):313-6. [Medline].

  37. Kojima KY, Koslin DB, Primack SL, Kettler MD. Synovial sarcoma arising from the pericardium: radiographic and CT findings. AJR Am J Roentgenol. Jul 1999;173(1):246-7. [Medline].

  38. Burke AP, Cowan D, Virmani R. Primary sarcomas of the heart. Cancer. Jan 15 1992;69(2):387-95. [Medline].

  39. Araoz PA, Eklund HE, Welch TJ, Breen JF. CT and MR imaging of primary cardiac malignancies. Radiographics. Nov-Dec 1999;19(6):1421-34. [Medline].

  40. Burke A. Primary malignant cardiac tumors. Semin Diagn Pathol. Feb 2008;25(1):39-46. [Medline].

  41. Khadilkar UN, Harish R, Tantry G, Kumar S, Tiwari A. Primary cardiac sarcoma. Indian J Pathol Microbiol. Jan-Mar 2008;51(1):30-1. [Medline].

  42. Shapiro S, Scott J, Kaufman K. Metastatic cardiac angiosarcoma of the cervical spine. Case report. Spine. Jun 1 1999;24(11):1156-8. [Medline].

  43. Romero-Menor C, Vadillo M, Martin F, et al. Cardiac angiosarcoma presenting as diffuse pulmonary disease. Eur Heart J. Dec 1995;16(12):2005-6. [Medline].

  44. Colon G, Quint DJ, Blaivas M, McGillicuddy J. Cardiac sarcoma metastatic to the brain. AJNR Am J Neuroradiol. Sep 1995;16(8):1739-41. [Medline].

  45. Kapoor A. Clinical manifestations of neoplasia of the heart. In: Kapoor A, ed. Cancer of the Heart. New York: Springer-Verlag;1986.

  46. McAdams HP, Schaefer PS, Ghaed VN. Leukemic infiltrates of the heart: CT findings. J Comput Assist Tomogr. May-Jun 1989;13(3):525-7. [Medline].

  47. Burn PR, Chinn R, King DM. Right atrial metastatic melanoma detected by dynamic contrast enhanced spiral CT. Br J Radiol. Apr 1999;72(856):395-6. [Medline].

  48. Cutrone JA, Georgiou D, Yospur LS, et al. Metastatic spread of cervical carcinoma to the right ventricle and pulmonary arteries: diagnosis by ultrafast computed tomography. Am J Card Imaging. Oct 1995;9(4):275-9. [Medline].

  49. Zissin R, Shapiro-Feinberg M, Rachmani R, Kots E. Lung metastasis invading the left atrium--CT diagnosis. Br J Radiol. Dec 1999;72(864):1211-2. [Medline].

  50. Korobkin M, Gasano VA. Intracaval and intracardiac extension of malignant thymoma: CT diagnosis. J Comput Assist Tomogr. Mar-Apr 1989;13(2):348-50. [Medline].

  51. Wigmore SJ, Garden OH. Images in hepatology: extension of hepatocellular carcinoma into the heart. J Hepatol. 1999;31:160. [Medline].

  52. Ogawa T, Ohwada S, Ohtaki A, et al. Successful resection of renal cell carcinoma with tumor thrombi extending into the right atrium: a case report. Hepatogastroenterology. Jul-Aug 1999;46(28):2535-9. [Medline].

  53. Vargas-Barron J, Keirns C, Barragan-Garcia R, et al. Intracardiac extension of malignant uterine tumors. Echocardiographic detection and successful surgical resection. J Thorac Cardiovasc Surg. Jun 1990;99(6):1099-103. [Medline].

  54. Rothenberg DM, Brandt TD, D''Cruz I. Computed tomography of renal angiomyolipoma presenting as right atrial mass. J Comput Assist Tomogr. Nov-Dec 1986;10(6):1054-6. [Medline].

  55. Steinmetz OK, Bedard P, Prefontaine ME, et al. Uterine tumor in the heart: intravenous leiomyomatosis. Surgery. Feb 1996;119(2):226-9. [Medline].

  56. Okamoto H, Itoh T, Morita S, et al. Intravenous leiomyomatosis extending into the right ventricle: one- stage radical excision during hypothermic circulatory arrest. Thorac Cardiovasc Surg. Dec 1994;42(6):361-3. [Medline].

  57. Kaszar-Seibert DJ, Gauvin GP, Rogoff PA, et al. Intracardiac extension of intravenous leiomyomatosis. Radiology. Aug 1988;168(2):409-10. [Medline].

  58. Pickuth D, Eeles R, Mason M, et al. Intracardiac metastases from germ cell tumours--an unusual but important site of metastasis. Br J Radiol. Aug 1992;65(776):672-3. [Medline].

  59. Paule B, Brion N, Grunenwald D, Andre-Bougaran J. Right atrial extension of an embryonal carcinoma of the testis. Cancer. Jul 1 1991;68(1):198-201. [Medline].

  60. Chandrashekar G. Choriocarcinoma presenting as intracardiac (intracavitary) tumour. Int J Cardiol. Jun 30 1995;50(2):197. [Medline].

  61. Haggerty MF, Murphy TM. Metastatic anaplastic thyroid carcinoma to the right ventricle of the heart. AJR Am J Roentgenol. Nov 1990;155(5):1136. [Medline].

  62. Sato Y, Togawa K, Ogawa K, et al. Magnetic resonance imaging of cardiac hemangiopericytoma. Heart Vessels. 1995;10(6):328-30. [Medline].

  63. Fukuda T, Ishikawa H, Ohnishi Y, et al. Malignant spindle cell tumor of the pericardium. Evidence of sarcomatous mesothelioma with aberrant antigen expression. Acta Pathol Jpn. Nov 1989;39(11):750-4. [Medline].

  64. el-Naggar AK, Ro JY, Ayala AG, et al. Localized fibrous tumor of the serosal cavities. Immunohistochemical, electron-microscopic, and flow-cytometric DNA study. Am J Clin Pathol. Nov 1989;92(5):561-5. [Medline].

  65. Watanabe M, Suzuki H, Fukutome K, et al. An autopsy case of a malignant pericardial mesothelioma in a Japanese young man. Pathol Int. Jul 1999;49(7):658-62. [Medline].

  66. Andreani SM, Tavecchio L, Giardini R, Bedini AV. Extrapericardial solitary fibrous tumour of the pericardium. Eur J Cardiothorac Surg. Jul 1998;14(1):98-100. [Medline].

  67. Romer W, Lorenz HM, Cesnjevar RA, Lell M. Detection of primary pericardial liposarcoma by CT. AJR Am J Roentgenol. Nov 1999;173(5):1415. [Medline].

  68. Doshi S, Halim M, Singh H, Patel R. Massive intrapericardial lipoma, a rare cause of breathlessness. Investigations and management. Int J Cardiol. Sep 30 1998;66(2):211-5. [Medline].

  69. Bitar FF, el-Zein C, Tawil A, et al. Intrapericardial teratoma in an adult: a rare presentation. Med Pediatr Oncol. Apr 1998;30(4):249-51. [Medline].

  70. Kim EE, Wallace S, Abello R, et al. Malignant cardiac fibrous histiocytomas and angiosarcomas: MR features. J Comput Assist Tomogr. Jul-Aug 1989;13(4):627-32. [Medline].

  71. Morinaga K, Kohyama N, Yokoyama K, et al. Asbestos fibre content of lungs with mesotheliomas in Osaka, Japan: a preliminary report. IARC Sci Publ. 1989;(90):438-43. [Medline].

  72. Santos C, Montesinos J, Castañer E, Sole JM, Baga R. Primary pericardial mesothelioma. Lung Cancer. May 2008;60(2):291-3. [Medline].

  73. Graca A, Nunes R, Costeira A, et al. Cardiac papillary fibroelastoma of a mitral valve chordae revealed by stroke. Rev Port Cardiol. Oct 1999;18(10):937-9. [Medline].

  74. Di Mattia DG, Assaghi A, Mangini A, et al. Mitral valve repair for anterior leaflet papillary fibroelastoma: two case descriptions and a literature review. Eur J Cardiothorac Surg. Jan 1999;15(1):103-7. [Medline].

  75. Cesena FH, Pereira AN, Dallan LA, et al. Papillary fibroelastoma of the mitral valve 12 years after mitral valve commissurotomy. South Med J. Oct 1999;92(10):1023-8. [Medline].

  76. de Menezes IC, Fragata J, Martins FM. Papillary fibroelastoma of the mitral valve in a 3-year-old child: case report. Pediatr Cardiol. May-Jun 1996;17(3):194-5. [Medline].

  77. Benvenuti LA, Mansur AJ, Lopes DO, Campos RV. Primary lipomatous tumors of the cardiac valves. South Med J. Oct 1996;89(10):1018-20. [Medline].

  78. Amonkar GP, Kandalkar BM, Balasubramanian M. Images in pathology cardiac rhabdomyoma. Cardiovasc Pathol. Apr 14 2008;[Medline].

  79. Günther T, Schreiber C, Noebauer C, Eicken A, Lange R. Treatment Strategies for Pediatric Patients with Primary Cardiac and Pericardial Tumors: A 30-Year Review. Pediatr Cardiol. Jul 4 2008;[Medline].

  80. de Bustamante TD, Azpeitia J, Miralles M, et al. Prenatal sonographic detection of pericardial teratoma. J Clin Ultrasound. May 2000;28(4):194-8. [Medline].

  81. Sievers RF, Tang AT, Haw MP. Complete surgical resection of intrapericardial teratoma in a neonate with compression of the central airways. Cardiol Young. Jan 2000;10(1):64-6. [Medline].

  82. Beghetti M, Gow RM, Haney I, et al. Pediatric primary benign cardiac tumors: a 15-year review. Am Heart J. Dec 1997;134(6):1107-14. [Medline].

  83. Sallee D, Spector ML, van Heeckeren DW, Patel CR. Primary pediatric cardiac tumors: a 17 year experience. Cardiol Young. Mar 1999;9(2):155-62. [Medline].

  84. Takatoh H, Iwamoto H, Ikezu M, et al. Cardiac rhabdomyoma. A case report with reference to atrial natriuretic peptide. Acta Pathol Jpn. Jan 1988;38(1):95-104. [Medline].

  85. Czechowski J, Langille EL, Varady E. Intracardiac tumour and brain lesions in tuberous sclerosis. A case report of antenatal diagnosis by ultrasonography. Acta Radiol. Jul 2000;41(4):371-4. [Medline].

  86. Kindman LA, Wright A, Tye T, et al. Lipomatous hypertrophy of the interatrial septum: characterization by transesophageal and transthoracic echocardiography, magnetic resonance imaging, and computed tomography. J Am Soc Echocardiogr. Nov-Dec 1988;1(6):450-4. [Medline].

  87. Webber MD, Selsky EJ, Roper PA. Identification of a mobile intracardiac rheumatoid nodule mimicking an atrial myxoma. J Am Soc Echocardiogr. Nov-Dec 1995;8(6):961-4. [Medline].

  88. Plehn J, Sager J, Foster E, et al. Pericardial pseudotumor. Echocardiographic observation of juxtacardiac pulmonary collapse. Chest. Oct 1988;94(4):837-41. [Medline].

  89. Atalay S, Imamoglu A, Uluoglu O, Ikizler C. Critical tricuspid regurgitation secondary to ruptured chordae tendineae mimicking a mass on the tricuspid valve in a newborn. Pediatr Cardiol. May-Jun 1995;16(3):133-6. [Medline].

  90. Harrity PJ, Tazelaar HD, Edwards WD, et al. Intracardiac varices of the right atrium: a case report and review of the literature. Int J Cardiol. Feb 1995;48(2):177-81. [Medline].

  91. Ewy MF, Demmy TL, Perry MC, et al. Massive phrenic perineurioma mimicking an unresectable cardiac tumor. Ann Thorac Surg. Jul 1995;60(1):188-9. [Medline].

  92. Urba W, Longo D. Primary solid tumors of the heart. In: Kapoor A, ed. Cancer of the Heart. New York: Springer-Verlag;1986.

  93. McAllister HA Jr. Primary tumors and cysts of the heart and pericardium. Curr Probl Cardiol. May 1979;4(2):1-51. [Medline].

  94. Hoffmann U, Globits S, Frank H. Cardiac and paracardiac masses. Current opinion on diagnostic evaluation by magnetic resonance imaging. Eur Heart J. Apr 1998;19(4):553-63. [Medline].

  95. Vanderheyden M, De Sutter J, Wellens F, Andries E. Left atrial lipoma: case report and review of the literature. Acta Cardiol. 1998;53(1):31-2. [Medline].

  96. Roberts WC. Cardiac Neoplasms. In: Topol EJ, ed. Textbook of Cardiovascular Medicine. Philadelphia Pa: Lippincott-Raven publishers;. 1998:971-74.

  97. Mader MT, Poulton TB, White RD. Malignant tumors of the heart and great vessels: MR imaging appearance. Radiographics. Jan-Feb 1997;17(1):145-53. [Medline].

  98. Burke AP, Rosado-de-Christenson M, Templeton PA, Virmani R. Cardiac fibroma: clinicopathologic correlates and surgical treatment. J Thorac Cardiovasc Surg. Nov 1994;108(5):862-70. [Medline].

  99. Parmley LF, Salley RK, Williams JP, Head GB 3rd. The clinical spectrum of cardiac fibroma with diagnostic and surgical considerations: noninvasive imaging enhances management. Ann Thorac Surg. Apr 1988;45(4):455-65. [Medline].

  100. Lewis CM. Clinical presentation and investigation of cardiac tumors. Semin Diagn Pathol. Feb 2008;25(1):65-8. [Medline].

  101. Mousseaux E, Hernigou A, Azencot M, et al. Evaluation by electron beam computed tomography of intracardiac masses suspected by transoesophageal echocardiography. Heart. Sep 1996;76(3):256-63. [Medline].

  102. Restrepo CS, Largoza A, Lemos DF, Diethelm L, Koshy P, Castillo P, et al. CT and MR imaging findings of malignant cardiac tumors. Curr Probl Diagn Radiol. Jan-Feb 2005;34(1):1-11. [Medline].

  103. Link KM, Lesko NM. MR evaluation of cardiac/juxtacardiac masses. Top Magn Reson Imaging. Fall 1995;7(4):232-45. [Medline].

  104. Sparrow PJ, Kurian JB, Jones TR, Sivananthan MU. MR imaging of cardiac tumors. Radiographics. Sep-Oct 2005;25(5):1255-76. [Medline].

  105. Carrol CL, Higgins CB, Caputo GR. Magnetic resonance imaging of acquired cardiac disease. Tex Heart Inst J. 1996;23(2):144-54. [Medline].

  106. Centofanti P, Patane F, Barbato L, et al. Left atrial approach to big myxoma with angiographically visible neovascularity. Report of one case. J Cardiovasc Surg (Torino). Jun 1999;40(3):391-3. [Medline].

  107. Sawaya JI, Dakik HA. Angiographic visualization of an atrial myxoma. N Engl J Med. Jan 27 2000;342(4):294-5. [Medline].

  108. Balkin PW, Imoto EM. Treatment of malignant obstruction of the right ventricular outflow tract and pulmonary artery with metallic stents. AJR Am J Roentgenol. Aug 1997;169(2):439-40. [Medline].

Keywords

cardiac tumor, heart tumor, heart neoplasm, primary cardiac tumors, secondary cardiac tumors, cardiac neoplasms, heart tumors, benign cardiac tumor, heart neoplasm, pericardial tumor, pericardial neoplasm, cardiac masses, pericardial masses, cardiac pseudotumors, myxoma, endodermal tumor, cardiac sarcoma, cardiac valve tumor, pediatric cardiac tumors, cardiac tumors in childhood, rhabdomyosarcoma, pediatric rhabdomyoma

Contributor Information and Disclosures

Author

Julia Gates, MD, Consulting Staff and Assistant Residency Program Director, Department of Radiology, Baystate Medical Center
Julia Gates, MD is a member of the following medical societies: Alpha Omega Alpha, American Heart Association, American Roentgen Ray Society, Association of University Radiologists, Massachusetts Medical Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

Coauthor(s)

George Hartnell, MB, Professor of Radiology, Tufts University School of Medicine, Director of Cardiovascular and Interventional Radiology, Department of Radiology, Baystate Medical Center
George Hartnell, MB is a member of the following medical societies: American College of Cardiology, American College of Radiology, American Heart Association, Association of University Radiologists, British Institute of Radiology, British Medical Association, Massachusetts Medical Society, Radiological Society of North America, Royal College of Physicians, Royal College of Radiologists, and Society of Cardiovascular and Interventional Radiology
Disclosure: Nothing to disclose.

Medical Editor

Justin D Pearlman, MD, PhD, ME, MA, Director of Dartmouth Advanced Imaging Center, Professor of Medicine, Professor of Radiology, Adjunct Professor, Thayer Bioengineering and Computer Science, Dartmouth-Hitchcock Medical Center
Justin D Pearlman, MD, PhD, ME, MA is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Federation for Medical Research, International Society for Magnetic Resonance in Medicine, and Radiological Society of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

John D Newell, Jr, MD, FACR, FCCP, FASER, Co-Director of Thoracic Imaging, UCDHSC; Director of Lung Imaging Center, Professor of Radiology and Professor of Medicine, Department of Radiology, University of Colorado Health Sciences Center, National Jewish Medical and Research Center; Univ. Colorado Hospital
John D Newell, Jr, MD, FACR, FCCP, FASER is a member of the following medical societies: American College of Chest Physicians, American College of Radiology, American Roentgen Ray Society, American Thoracic Society, Association of University Radiologists, Radiological Society of North America, and Society of Thoracic Radiology
Disclosure: Siemens Medical Grant/research funds Consulting; Forevision Technologies Ownership interest Consulting; Vida Corporation Ownership interest Board membership; TeraRecon Grant/research funds Consulting; eMedicine Honoraria Consulting

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Clinical Assistant Professor of Radiology, University of Washington Medical School
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

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