Cardiac Masses: The Role of Cardiovascular Imaging in the Differential Diagnosis

Abstract

Cardiac masses are space occupying lesions within the cardiac cavities or adjacent to the pericardium. They include frequently diagnosed clinical entities such as clots and vegetations, common benign tumors such as myxomas and papillary fibroelastomas and uncommon benign or malignant primary or metastatic tumors. Given their diversity, there are no guidelines or consensus statements regarding the best diagnostic or therapeutic approach. In the past, diagnosis used to be made by the histological specimens after surgery or during the post-mortem examination. Nevertheless, evolution and increased availability of cardiovascular imaging modalities has enabled better characterization of the masses and the surrounding tissue. Transthoracic echocardiography using contrast agents can evaluate the location, the morphology and the perfusion of the mass as well as its hemodynamic effect. Transesophageal echocardiography has increased spatial and temporal resolution; hence it is superior in depicting small highly mobile masses. Cardiac magnetic resonance and cardiac computed tomography are complementary providing tissue characterization. The scope of this review is to present the role of cardiovascular imaging in the differential diagnosis of cardiac masses and to propose a step-wise diagnostic algorithm, taking into account the epidemiology and clinical presentation of the cardiac masses, as well as the availability and the incremental value of each imaging modality.

Case Report: An Unusual Case of Biventricular Thrombosis in a COVID-19 Patient With Ischemic Dilated Cardiomyopathy: Assessment of Mass Mobility and Embolic Risk by Tissue Doppler Imaging

“…In the present case, contrast echocardiography, which is particularly advantageous for detection of small or mural thrombi (27), was not performed to confirm the diagnosis of LV and RV apical thrombi, because both thrombotic masses were large in size and protuberant in shape. On the other hand, PW-TDI was useful to precisely assessing the mobility of the intracardiac thrombi.…”

Role of Echocardiography in Diagnosing Metastatic Testicular Carcinoma in a Young Patient Presenting as Right Heart Failure

“…CMR is on par with cardiac CT for tissue characterization, such as characterization of fat tissue and edema, but CMR is superior in assessing cellular iron content. 7 However, histopathologic diagnosis remains the only means of definitive diagnosis. 8 Options for obtaining a tissue diagnosis include surgical biopsy, direct percutaneous biopsy, and transcatheter biopsy (TCB).…”

Myxoma in patients with hypertrophic obstructive cardiomyopathy. Retrospective single-center analysis

“…Nevertheless, both these modalities have their limitations in differentiating intra-cardiac tumors. The role of complementary imaging modalities of cardiac masses is discussed in detail elsewhere [9].…”