Cardiac tumors
Cardiac tumors can be primary (benign or malignant) or metastatic
Primary Benign (Intracardiac)
Types
- Myxoma (most common benign tumor found in the adults: 30%)
- Papilloma (10%)
- Lipoma (10%)
- Fibroma (4%)
- Rhabdomyoma (adult: 8.5%; most common benign tumor found in children); occurs more often in the right ventricle than in the left ventricle
Myxoma
Definition
A benign cardiac tumor that is usually attached by a stalk to the interatrial septum. Since the tumor is usually mobile and moves with the blood flow, it may completely or partially prolapse into the left ventricle during diastole.
Signs and Symptoms
- Fever
- Cachexia
- Malaise
- Arthralgias
- Raynaud's phenomenon
- Rash
- Clubbing
Complications
- Systemic emboli
- Pulmonary emboli
Cardiac Auscultation
- Mimics the findings of mitral stenosis
- Endocardial friction rub
Electrocardiogram
- Arrhythmia
- Atrial fibrillation, atrial flutter
- Conduction disturbances
- Bundle branch block
Chest X-ray
- Pulmonary edema or pulmonary venous distention
- Abnormal cardiac silhouette
- Unusual intracardiac calcification
Treatment
- Prompt surgical excision
- Serial echocardiography to rule out recurrence
M-Mode
- Blunted E point of the mitral valve
- Reduced E-F slope
- Heavy band of echoes behind the anterior mitral leaflet in diastole
- Echo-free space at anterior mitral leaflet at the onset of diastole prior to dense echoes from tumor
2-D
- Dramatic motion of the myxoma prolapsing from the left atrium into the left ventricle
- Allows detection and sizing of the myxoma
Doppler
- Mimics findings of valvular mitral stenosis
- Mitral regurgitation
Papilloma (Fibroelastoma)
- Found on the endocardial surfaces of the atrioventricular valves or ventricular endocardium
- Rarely exceeds 1 cm in diameter
- Infrequently needs surgical attention
Lipoma (Lipomatous Hypertrophy of the Interatrial Septum)
- Thickened interatrial septum
- "Dumb-bell" appearance with sparing of the fossa ovalis
Fibroma
- Highly refractile
- Frequently embedded in the myocardial wall
- Associated with ventricular arrhythmias
- May be surgically excised
Rhabdomyoma
- Most common tumor found in children
- Associated with tuberous sclerosis
- Found in the ventricular walls (more common in the right ventricle)
Primary Malignant Intracardiac tumors
Angiosarcoma
- Found in the atrial walls and pericardium: may compromise the inflow portions of the ventricles
- Associated with pericardial effusion, cardiac tamponade
Sarcoma
- Most commonly seen in the right atrium
Secondary Tumors (Metastatic)
- More common than primary tumors
- Pericardial more often than myocardial involvement
- Sarcoma, melanoma, malignancy of breast or lung; lymphoma can invade myocardium
- Renal, liver, Wilm's tumors extend from the inferior vena cava to the right atrium and right ventricle
- Extracardiac Tumors
- Mediastinal cysts, hematoma, thymoma, teratoma, diaphragmatic hernia, pancreatic cyst
- Cyst, lymphoma
- Pericardial involvement
- Pleural tumor