Metastatic Involvement of the Heart and Pericardium: CT and MR Imaging

Abstract

Metastases to the heart and pericardium are much more common than primary cardiac tumors and are generally associated with a poor prognosis. Tumors that are most likely to involve the heart and pericardium include cancers of the lung and breast, melanoma, and lymphoma. Tumor may involve the heart and pericardium by one of four pathways: retrograde lymphatic extension, hematogenous spread, direct contiguous extension, or transvenous extension. Metastatic involvement of the heart and pericardium may go unrecognized until autopsy. Impairment of cardiac function occurs in approximately 30% of patients and is usually attributable to pericardial effusion. The clinical presentation includes shortness of breath, which may be out of proportion to radiographic findings in patients with pericardial effusion or may be the result of associated pleural effusion. Patients may also present with cough, anterior thoracic pain, pleuritic chest pain, or peripheral edema. The differential diagnosis of pericardial effusion in a patient with known malignancy includes malignant pericardial effusion, radiation-induced pericarditis, drug-induced pericarditis, and idiopathic pericarditis. Any disease process that causes thickening or nodularity of the pericardium or myocardium or masses within the cardiac chambers can mimic metastatic disease.

CT Findings in Patients With Pericardial Effusion: Differentiation of Malignant and Benign Disease

“…The differential diagnosis of pericardial effusion in patients with malignant disease includes malignant pericardial effusion, radiation-induced pericarditis, drug-induced pericarditis, and idiopathic pericarditis [20]. Metastatic pathways to the pericardium can be lymphatic or direct extension [21].…”

A rare case of primitive right atrium angio-sarcoma with favorable outcome, in a young female: Case report and literature review

“…Computed tomography is able to better define calcification, the study time is shorter and the procedure is essentially useful when MR is contraindicated. It also allows the diagnosis by means of guided transthoracic biopsies 20 .…”

Atrial Metastatic Tumor: Transthoracic and Transesophageal Echocardiograph Imaging

“…Imaging studies valuable to establish the diagnosis include (2D, 3D) transthoracic and transesophageal echocardiogram [19], CT scan, MR imaging [10] and angiography. Still, metastatic cardiac lesions, most of which are clinically silent, are often only found post-mortem.…”

“…Both imaging modalities provide a large examining field which allows evaluation of disease throughout the thorax [10].…”