Benign or Malignant Cardiac Mass: Refining the Role of Cardiac Magnetic Resonance

Abstract

ardiac masses can be classified as neoplastic (primary benign, primary malignant, and metastatic), nonneoplastic (thrombi, vegetation, and calcifications), and pseudotumors (lipomatous hypertrophy of the interatrial septum, crista terminalis, Eustachian valve, Chiari formation, and Coumadin ridge). Cardiac masses may be found in the evaluation of cardiac symptoms or in the pursuit of unrelated complaints. In view of their rarity (0.002%-0.003% in autopsy studies) 1 and great diversity, guidelines and consensus statements tackling the diagnostic approach to neoplastic masses are as scarce as cardiac tumors, and those that exist offer little guidance. 2 While the history, physical, and ECG offer important clues, cardiac imaging provides the critical information needed to discriminate benign from malignant masses vital for clinical decision-making and prognostication. Noninvasive imaging modalities include echocardiography (transthoracic, transesophageal, and ultrasound-enhancing agents), cardiac magnetic resonance (CMR), computed tomography, and 18 fluorodeoxyglucose positron-emission tomography. The gold standard is tissue biopsy, which is generally reserved for inconclusive noninvasive studies.