Intrinsic and Extrinsic Cardiac Pseudotumors: Echocardiographic Evaluation and Review of the Literature

Abstract

Echocardiography is the most common imaging modality for the assessment of cardiovascular tumors, followed by more advanced imaging modalities, such as cardiac computed tomography or cardiac magnetic resonance imaging. Non-neoplastic lesions that may simulate a true neoplasm on imaging are termed "cardiac pseudotumors." As echocardiography is the initial imaging modality where pseudotumors are identified, it is imperative to have a fundamental understanding of pseudotumors evaluation using echocardiography. There is paucity of the literature describing the different kinds of pseudotumors. This review is an attempt to describe common cardiac pseudotumors and to classify them based on their origin. The tumors arising from cardiac structures, such as epicardium, endocardium, or myocardium, were termed as "intrinsic" while the pseudotumors with no cardiac origin were termed as "extrinsic." The more common pseudotumors are described in detail with pertinent echocardiographic features and examples.

Differentiating benign from malignant cardiac tumors with cardiac magnetic resonance imaging

“…Oftentimes, however, normal anatomic structures may be classified as tumors on echocardiography. 21 This was demonstrated in our study, because numerous patients who were referred for tumor evaluation did not have any evidence of a cardiac mass on CMR. In this study, however, our primary focus was to describe the CMR characteristics of benign and malignant tumors.…”

Position Statement on Indications of Echocardiography in Adults - 2019

“…As regards incidence, the most frequent causes of cardiac masses are thrombi and vegetation, and rarely are tumors and pseudotumors (intrinsic and extrinsic structures that mimic a cardiac tumor). 223 Cardiac tumors are extremely rare, with secondary tumors (metastatic neoplasms) being 20 times more frequent than primary tumors. 224,225 Although the classification of these lesions for benignity or malignancy is an important predictor of prognosis, any cardiac tumor may have substantial hemodynamic or electrical consequences depending on size and location.…”

New-onset cardiac mass due to left atrial appendage inversion during cardiac surgery

“…Other differential diagnoses were a tumor (myxoma, considering the localization), vegetation, or anatomic variants and artifacts. 1 We evaluated each of these possibilities, taking into account that a previous normal examination would have ruled out tumors and vegetations. Regarding anatomic variants, the only one would be a prominent left upper pulmonary vein ridge, but the high mobility and size did not agree with this diagnosis.…”