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]

Electrocardiography

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.

Procedures

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).

Treatment & Management

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Media Gallery

Angiosarcoma of the heart, with pericardial encasement by hemorrhagic tumor. Image courtesy of Dr. K. Marchant.

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Author

John H Raaf, MD, PhD (Retired) Professor, Department of Surgery, Case Western Reserve University School of Medicine

John H Raaf, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American College of Surgeons, Central Surgical Association, Society of Surgical Oncology, American Association of Endocrine Surgeons, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Coauthor(s)

Anastasios K Konstantakos, MD Clinical Associate Surgeon, Department of Cardiovascular Surgery, Billings Clinic

Disclosure: Nothing to disclose.

Heather N Raaf, MD (Retired) Chief Deputy Coroner, Cuyahoga County Coroner's Office

Heather N Raaf, MD is a member of the following medical societies: National Association of Medical Examiners, American Academy of Forensic Sciences

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Eric H Yang, MD Associate Professor of Medicine, Director of Cardiac Catherization Laboratory and Interventional Cardiology, Mayo Clinic ArizonA

Eric H Yang, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Additional Contributors

Robert C Shepard, MD, FACP Associate Professor of Medicine in Hematology and Oncology at University of North Carolina at Chapel Hill; Vice President of Scientific Affairs, Therapeutic Expertise, Oncology, at PRA International

Robert C Shepard, MD, FACP is a member of the following medical societies: American Association for Cancer Research, American Association for Physician Leadership, European Society for Medical Oncology, Association of Clinical Research Professionals, American Federation for Clinical Research, Eastern Cooperative Oncology Group, Society for Immunotherapy of Cancer, American Medical Informatics Association, American College of Physicians, American Federation for Medical Research, American Medical Association, American Society of Hematology, Massachusetts Medical Society

Disclosure: Nothing to disclose.