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Learning Modules ❯ Cardiac

Atrial Myxoma vs Thrombus: Key Differential Dx Parameters

CT attenuation of mass
Size of mass
Left vs right atrium
Origin of mass
Lesion shape
Lesion mobility
Occurrence of prolapse

Atrial Myxoma vs Thrombus: Key Differential Dx Parameters

CT attenuation of mass- no significant difference
Size of mass
Left vs right atrium
Origin of mass
Lesion shape
Lesion mobility
Occurrence of prolapse

Atrial Myxoma vs Thrombus: Key Differential Dx Parameters

CT attenuation of mass- no significant difference
Size of mass- myxomas are usually larger
Left vs right atrium
Origin of mass
Lesion shape
Lesion mobility
Occurrence of prolapse

Atrial Myxoma vs Thrombus: Key Differential Dx Parameters

CT attenuation of mass- no significant difference
Size of mass- myxomas are usually larger
Left vs right atrium- no difference
Origin of mass
Lesion shape
Lesion mobility
Occurrence of prolapse

Atrial Myxoma vs Thrombus: Key Differential Dx Parameters

CT attenuation of mass- no significant difference
Size of mass- myxomas are usually larger
Left vs right atrium- no difference
Origin of mass- thrombi usually in left atrial appendage
Lesion shape
Lesion mobility
Occurrence of prolapse

Atrial Myxoma vs Thrombus: Key Differential Dx Parameters

CT attenuation of mass- no significant difference
Size of mass- myxomas are usually larger
Left vs right atrium- no difference
Origin of mass- thrombi usually in left atrial appendage
Lesion shape- villous shape more common in myxomas
Lesion mobility
Occurrence of prolapse

Atrial Myxoma vs Thrombus: Key Differential Dx Parameters

CT attenuation of mass- no significant difference
Size of mass- myxomas are usually larger
Left vs right atrium- no difference
Origin of mass- thrombi usually in left atrial appendage
Lesion shape- villous shape more common in myxomas
Lesion mobility- myxomas more commonly mobile
Occurrence of prolapse

Atrial Myxoma vs Thrombus: Key Differential Dx Parameters

CT attenuation of mass- no significant difference
Size of mass- myxomas are usually larger
Left vs right atrium- no difference
Origin of mass- thrombi usually in left atrial appendage
Lesion shape- villous shape more common in myxomas
Lesion mobility- myxomas more commonly mobile
Occurrence of prolapse- no difference

Clot in Right Atrium

Fever, SOB

Thrombus on Catheter in the Right Atrium

Papillary Fibroelastoma: Facts

Papillary fibroelastoma is the third most common primary benign cardiac tumor with an incidence of up to 0.33 % in autopsy series
Papillary fibroelastomas account for approximately 75 % of all cardiac valvular tumors and affect men and women equally with a mean age of 60 years
They are characterized by a collection of avascular fronds of dense connective tissue lined by endothelium and may arise from any endocardial surface, though the majority are found on the aortic and mitral valves. Most papillary fibroelastomas are solitary and small with an average diameter of 10 mm.

“ Cardiac papillary fibroelastomas are classified as primary benign endocardial tumours arising from the normal component of the endocardium like fibrous tissue, elastic fibers or smooth muscle cells. Characteristically they have a short pedicle and multiple papillary fronds similar to a sea anemone . They often (85%) originate from the valvular endocardium. The aortic valve (29%), mitral valve (25%), tricuspid valve (17%) and pulmonary valves (13%) are involved in that order.”
Papillary fibroelastoma of the aortic valve - a case report and literature review
Jha NK et al.
Journal of Cardiothoracic Surgery 2010, 5:84

Papillary Fibroelastoma

Papillary Fibroelastoma in Patient with Chest Pain

Cardiac Lipoma

Lipoma is the second most common primary benign cardiac neoplasm (8% to 12%) and most commonly occurs in middle-aged and older adults.
Approximately 50% of lipomas originate from the subendocardial layer, and the other half arise from the subepicardial or myocardial layers and grow into the pericardial sac.
They are typically asymptomatic but may cause arrhythmias or valvular dysfunction . Subepicardial lipomas can compress the coronary arteries, which leads to ischemic chest pain.

Cardiac Lipoma

Lipoma is the second most common primary benign tumor and accounts for approximately 10 % of primary cardiac tumors
Lipomas commonly occur in middle-aged and older adults.
Lipomas are encapsulated, well-circumscribed tumors consisting of mature adipocytes that can occur any- where in the heart. Approximately 50 % arise in the epicardial or mid-myocardial layers, while the other half are subendocardial, where they create filling defects with a homogenous appearance of fat attenuation (density < -50 Hounsfield units [HU]).

Benign Cardiac Tumor – Lipoma

Benign neoplasm composed of mature adipose tissue
Occurs as solitary or multiple tumors
Well circumscribed fat density mass
DDX: Lipomatous hypertrophy of interatrial septum
- Spares interatrial septum

Cardiac Masses on Cardiac CT: A Review
David Kassop et al.
Curr Cardiovasc Imaging Rep (2014) 7:9281

Cardiac Angiosarcoma

Angiosarcoma is the most common primary cardiac malignant tumor and is comprised of cells that develop multiple, irregular vascular channels. The primary site of origin is the right atrial free wall in 80 % of cases and less commonly the right ventricle or pericardium The tumor morphology typically consists of a large, multilobar mass with a heterogeneous composition that spreads along the epicardial surface and replaces the right atrial wall
These tumors may also be localized to the pericardium and often invade adjacent cardiac structures leading to cardiomegaly and recurrent pericardial effusions

Cardiac Angiosarcoma: Facts

highly aggressive tumors consisting of irregularly shaped vascular channels lined by anaplastic epithelial cells with sizeable areas of necrosis and hemorrhage.
They preferentially affect men and have a peak incidence in the fourth decade of life.
They are of right atrial origin in approximately 75% of cases and typically fill this chamber and then infiltrate into the pericardium, tricuspid valve, right ventricle, and right coronary artery .
Metastases develop in 47% to 89% of patients, most commonly to the lungs but also to the bone, colon, and brain. Patients typically present with symptoms of right heart failure, shortness of breath due to hemopericardium, and palpitations secondary to supraventricular arrhythmias.

”Cardiac angiosarcomas are the most common pri- mary cardiac malignancy in adults with specific differentiation, accounting for 40% of cardiac sar- comas. Patients are usually younger than 65 years, peaking in the fourth to fifth decade, with a slight male preponderance of 1.3:1. Cardiac angiosarcomas occur almost exclusively in the right atrium near the atrioventricular sulcus (80%–90% of cases). Symptoms generally result from obstruction, tumor emboli, or local invasion into the myocardium and atrial free wall.”
Cardiac Neoplasms Radiologic-Pathologic Correlation
John P. Lichtenberger III et al.
Radiol Clin N Am 59 (2021) 231–242

”Cardiac angiosarcomas occur in the right atrium 80% to 90% of the time. At surgical resection, the mass typically projects into the cardiac chambers with permeative growth into the myocardium and local invasion of the pericardium, vena cava, tricuspid valve, and even the coronary arteries. Gross pathology reveals a large lobulated mass that is dark red and brown in color, reflecting its hemorrhagic and necrotic components. If pericardial invasion is present, a thickened rind of gray- black tissue is observed that is inseparable from the remainder of the tumor.”
Cardiac Neoplasms Radiologic-Pathologic Correlation
John P. Lichtenberger III et al.
Radiol Clin N Am 59 (2021) 231–242

Cardiac Angiosarcoma

Angiosarcoma of Right Atrium

Cardiac Angiosarcoma