Cardiac Sarcoma Workup

Updated: Sep 21, 2023
  • Author: John H Raaf, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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Imaging Studies

Advances in diagnostic techniques have facilitated accurate, noninvasive assessment of cardiac sarcomas. [16]

Echocardiography is the preferred diagnostic procedure for noninvasive imaging of cardiac tumors (2-dimensional and transesophageal echocardiography are complementary). [17] Findings on echocardiography can direct further workup by cardiac magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography (PET), and/or biopsy. [7]

The role of other imaging studies includes the following:

  • Chest radiography may reveal generalized cardiomegaly or right-sided heart enlargement, widened mediastinum, hilar adenopathy, pulmonary congestion, or pleural effusion.
  • CT scanning is useful in detecting cardiac lesions, documenting local invasion of adjacent structures, and defining the presence of lung or liver metastases.
  • Angiography can help assess coronary artery luminal status and document intracardiac and intravascular tumors as filling defects.
  • MRI has the potential to define tumor histology, tumor location, and surrounding anatomy and to detect response to chemotherapy. [18, 19] A study by Fussen et al found that comprehensive cardiovascular MRI is useful in risk stratification and clinical management in patients with suspected cardiac tumors. [20]
  • PET/CT) can characterize intracardiac masses and estimate tumor burden, as well as identify any extracardiac primary malignancy. [21]


More than 75% of patients with cardiac sarcomas have electrocardiography (ECG) abnormalities. These are generally nonspecifi, as follows:

  • Myocardial tumors can cause arrhythmias or various degrees of heart block.
  • Nonspecific ST and T wave changes may be observed.
  • Pericardial lesions may cause tachycardia and decreased voltage.


Pericardiocentesis allows cytologic examination and may relieve tamponade.

Endomyocardial biopsy provides tissue to use in diagnosis; however, this biopsy is not absolutely necessary preoperatively because tissue is obtained during surgical exploration.


Histologic Findings

Specific subtypes of cardiac sarcomas have characteristic gross and microscopic features (see Overview/Pathophysiology).