Malignant tumors of the heart and great vessels: MR imaging appearance.

Abstract

Fortunately, primary tumors of the heart and great vessels are rare. These primary tumors include angiosarcoma, malignant fibrous histiocytoma, high-grade and pleomorphic sarcoma, and paraganglioma with pericardial and myocardial invasion. Symptoms are often nonspecific and include chest pain and dyspnea. Although these tumors are often diagnosed with echocardiography and computed tomography, magnetic resonance (MR) imaging currently appears to be the imaging modality of choice because of its diverse capabilities, which include multiplanar imaging for excellent anatomic definition of the heart, pericardium, mediastinum, and lungs; improved morphologic differentiation between tumor tissue and surrounding cardiovascular, mediastinal, or pulmonary tissues; dynamic imaging with a gated cine-loop acquisition; and assessment of tissue perfusion. The use of gadopentetate dimeglumine is helpful in achieving tumor enhancement on MR images but is not required. MR imaging is also useful in assessing tumor response to surgery, radiation therapy, and chemotherapy.

Primary cardiac sarcoma

“…MRI allows better soft-tissue characterization than CT, is the modality of choice for evaluating myocardial and pericardial involvement [45], and provides functional information such as flow direction and velocity in large vessels [46]. MRI has diverse capabilities including multiplanar imaging, and can also assess tumour volume [47], tumour burden and response to surgery, radiation, and chemotherapy [48]. The differences in signal intensity between the heart and the adjacent structures permit MRI to define mediastinal invasion [49].…”

“…They spread intraluminally along the direction of blood flow [58]. Transmural extension into the adjacent lung, bronchi or lymph nodes occurs in 50% of cases [48]. Systemic metastases occur in 20% of cases and include the kidneys, brain, and lymph nodes.…”

Large Vessel Vasculitis with an Isolated Lesion of a Single-lobe Pulmonary Artery

“…Intimal sarcoma of the pulmonary artery was reported to have a prevalence of 0.001% based on autopsy findings (6). Generally, a lesion of the pulmonary intimal sarcoma is localized to a single pulmonary artery, as in this case (7).…”

Ruptured cardiac angiosarcoma with pulmonary metastases: A rare disease with a common (mis)diagnosis!

“…On the other hand, magnetic resonance imaging (MRI) currently appears to be the imaging modality of choice in the assessment of a patient with known cardiac mass. 13 Treatment of angiosarcoma is controversial due to the poor prognosis. Surgical resection is indicated when no evidence of metastasis exists and when myocardial resection is reparative.…”