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Imaging morphology of cardiac tumours

Shi-Min Yuan, Amihay Shinfeld, Jacob Lavee, Rafael Kuperstein, Rami Haizler, Ehud Raanani
Cardiology Journal 2009, 16 (1): 26-35

BACKGROUND: Cardiac tumours are very uncommon and are the topic of little investigation. Imaging features offer reliable diagnostic evidence for cardiac tumours, but diagnostic confusion may arise when tumours with similar features are present.

METHODS: Between January 2003 and July 2008, 34 patients were operated on for cardiac tumours in this institute. The patients' ages ranged from 31 to 81 years with an average of 54.8 +/- 14.2 years. Thirty (88.2%) tumours were primary [19 (55.9%) myxomas, 8 (23.5%) papillary fibroelastomas, and 1 (2.9%) cavernous hemangioma were benign, 1 (2.9%) recurrent fibrous histiocytoma (undifferentiated sarcoma) and 1 (2.9%) leiomyosarcoma were malignant], and 4 (11.8%) were secondary [1 (2.9%) metastatic cardiac leiomyoma, and 3 (8.8%) were renal cell carcinomas].

RESULTS: Cardiac myxomas represented more than half of the cardiac tumours of this patient series, necessitating surgical resection. More than half of these cardiac myxomas originated from the intraatrial septum with a stalk. Most of them appeared as a round or ovoid soft mass on echo, as a hypoattenuated lesion on computed tomography or magnetic resonance imaging, and with a soft gelatinous appearance on gross appearance. Cardiac papillary fibroelastomas were valvular or subvalvular, mostly pedicled by a short stalk, and all of them were pound 1 cm in size. The cavernous hemangioma was isointense on magnetic resonance imaging and tensile and slithy in gross specimen. Recurrent fibrous histiocytoma, leiomyosarcoma, intravenous leiomyoma and renal cell carcinoma resembled a myxoma on echocardiography due to their soft, friable, and mobile features. There were no misdiagnoses based on preoperative imaging features comparable to surgical and histopathologic findings in this surgical series.

CONCLUSIONS: Imaging morphology plays a key role in the preoperative differential diagnosis of cardiac tumours. Imaging features could reliably predict primary versus secondary, and benign versus malignant among cardiac tumours. The accurate preoperative imaging assessment of cardiac tumours necessitating surgical resection has become increasingly important in the decision-making of a surgical approach, method, and resection extent.

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