Myxoma other imaging findings: Difference between revisions

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Other diagnostic study for cardiac myxoma includes cardiac angiography, which often demonstrates contrast media-enhanced tumor vasculature.
Other diagnostic study for cardiac myxoma includes cardiac angiography, which often demonstrates contrast media-enhanced tumor vasculature.
<ref name="pmid16450793">{{cite journal |vauthors=Huang CY, Yu WC, Chen KC, Lin SJ |title=Coronary angiography of cardiac myxoma |journal=Clin Cardiol |volume=28 |issue=11 |pages=505–9 |year=2005 |pmid=16450793 |doi= |url=}}</ref>
<ref name="pmid16450793">{{cite journal |vauthors=Huang CY, Yu WC, Chen KC, Lin SJ |title=Coronary angiography of cardiac myxoma |journal=Clin Cardiol |volume=28 |issue=11 |pages=505–9 |year=2005 |pmid=16450793 |doi= |url=}}</ref>
==Other Imaging Findings==
==Other Imaging Findings==
===Cardiac Angiography===
===Cardiac Angiography===
The angiographic findings of cardiac myxoma demonstrate feeding vessels, contrast medium poolings, and clusters of tortuous vessels that correspond to tumor vasculature. In some cases, it is considered appropriate that older patients undergo coronary angiography to rule out the presence of ischemic heart diseases.<ref name="pmid10064362">{{cite journal |vauthors=Jelic J, Milicić D, Alfirević I, Anić D, Baudoin Z, Bulat C, Corić V, Dadić D, Husar J, Ivanćan V, Korda Z, Letica D, Predrijevac M, Ugljen R, Vućemilo I |title=Cardiac myxoma: diagnostic approach, surgical treatment and follow-up. A twenty years experience |journal=J Cardiovasc Surg (Torino) |volume=37 |issue=6 Suppl 1 |pages=113–7 |year=1996 |pmid=10064362 |doi= |url=}}</ref>
The angiographic findings of cardiac myxoma demonstrate feeding vessels, contrast medium poolings, and clusters of [[Tortuous|tortuous vessels]] that correspond to tumor vasculature. In some cases, it is considered appropriate that older patients undergo coronary angiography to rule out the presence of ischemic heart diseases.<ref name="pmid10064362">{{cite journal |vauthors=Jelic J, Milicić D, Alfirević I, Anić D, Baudoin Z, Bulat C, Corić V, Dadić D, Husar J, Ivanćan V, Korda Z, Letica D, Predrijevac M, Ugljen R, Vućemilo I |title=Cardiac myxoma: diagnostic approach, surgical treatment and follow-up. A twenty years experience |journal=J Cardiovasc Surg (Torino) |volume=37 |issue=6 Suppl 1 |pages=113–7 |year=1996 |pmid=10064362 |doi= |url=}}</ref>


'''Indications'''
'''Indications'''
*Coronary angiography may be performed to detect vascular supply of the tumor by the coronary arteries.<ref name="pmid21430425">{{cite journal |vauthors=Hasdemir H, Alper AT, Arslan Y, Erdinler I |title=[Left atrial myxoma with severe neovascularization: role of preoperative coronary angiography] |language=Turkish |journal=Turk Kardiyol Dern Ars |volume=39 |issue=2 |pages=163–5 |year=2011 |pmid=21430425 |doi=10.5543/tkda.2011.01284 |url=}}</ref><ref name="pmid2784254">{{cite journal |vauthors=Fueredi GA, Knechtges TE, Czarnecki DJ |title=Coronary angiography in atrial myxoma: findings in nine cases |journal=AJR Am J Roentgenol |volume=152 |issue=4 |pages=737–8 |year=1989 |pmid=2784254 |doi=10.2214/ajr.152.4.737 |url=}}</ref>
*Coronary angiography may be performed to detect vascular supply of the tumor by the coronary arteries.<ref name="pmid21430425">{{cite journal |vauthors=Hasdemir H, Alper AT, Arslan Y, Erdinler I |title=[Left atrial myxoma with severe neovascularization: role of preoperative coronary angiography] |language=Turkish |journal=Turk Kardiyol Dern Ars |volume=39 |issue=2 |pages=163–5 |year=2011 |pmid=21430425 |doi=10.5543/tkda.2011.01284 |url=}}</ref><ref name="pmid2784254">{{cite journal |vauthors=Fueredi GA, Knechtges TE, Czarnecki DJ |title=Coronary angiography in atrial myxoma: findings in nine cases |journal=AJR Am J Roentgenol |volume=152 |issue=4 |pages=737–8 |year=1989 |pmid=2784254 |doi=10.2214/ajr.152.4.737 |url=}}</ref>


{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+
! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF|Imaging Technique}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Features}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Description}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Advantages}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Limitations}}
|-
| style="padding: 5px 5px; background: #DCDCDC;" align=center|Two- or three-dimensional echocardiography
| style="padding: 5px 5px; background: #F5F5F5;" align=center|Echocardiography is usually the initial modality used for identification and evaluation of cardiac myxomas.
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
*Hyperechogenic lesions with a well-defined stalk
*Protrusion into the ventricles is a common finding
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
*Real-time imaging
*Tumor mobility and distensibility
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
*Limited views of the mediastinum and cannot be used to evaluate extracardiac manifestations of disease.<ref name="pmid1943240">{{cite journal |vauthors=Reeder GS, Khandheria BK, Seward JB, Tajik AJ |title=Transesophageal echocardiography and cardiac masses |journal=Mayo Clin. Proc. |volume=66 |issue=11 |pages=1101–9 |year=1991 |pmid=1943240 |doi= |url=}}</ref>
*TEE is an invasive imaging technique.
*TT is limited by the imaging window, which can vary with the patient and operator experience.
|-
| style="padding: 5px 5px; background: #DCDCDC;" align=center|MRI
| style="padding: 5px 5px; background: #F5F5F5;" align=center|Evaluation of cardiac masses and is of greatest value when echocardiographic findings are suboptimal or when the lesion has an atypical location or appearance.
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
*Cardiac myxomas appear spherical or ovoid with lobular contours, irregular in shape.
*'''T1''' : Low to intermediate signal, but areas of hemorrhage may be high.
*'''T1 C+ (Gd)''': shows enhancement (important discriminator from a thrombus) demonstrates uniform heterogeneous enhancement.
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
* MRI allows imaging in multiple planes
* Provides some functional information such as, flow direction and flow velocity in large vessels
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
*Cannot show calcification
*High susceptibility to motion artifact.
*Dependent on regular electrocardiographic rhythms and cardiac gating.
|-
| style="padding: 5px 5px; background: #DCDCDC;" align=center|CT
| style="padding: 5px 5px; background: #F5F5F5;" align=center|CT can be used to accurately image the heart and surrounding mediastinum
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
*Intracardiac heterogeneously low attenuating mass
*The attenuation is usually lower than that of myocardium
*Calcification is common
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
*CT provides better soft-tissue contrast
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
*There is no real-time true imaging with CT and imaging planes are limited to those allowed by angulation of the gantry.
*There is no evaluation of small moving structures, such as the cardiac valves.
|-
| style="padding: 5px 5px; background: #DCDCDC;" align=center|Angiography
| style="padding: 5px 5px; background: #DCDCDC;" align=center|Coronary angiography may be helpful to detect vascular supply of the tumor by the coronary arteries
| style="padding: 5px 5px; background: #DCDCDC;" align=center|
*The angiographic findings of cardiac myxoma demonstrate feeding vessels, contrast medium poolings, and clusters of tortuous vessels that correspond to tumor vasculature
| style="padding: 5px 5px; background: #DCDCDC;" align=center|
*Angiography can detect the concomitant coronary disease and the unique vascular appearances of cardiac myxoma
*Helpful for surgical evaluation
| style="padding: 5px 5px; background: #DCDCDC;" align=center|
*Invasive imaging technique
|-
| style="padding: 5px 5px; background: #DCDCDC;" align=center|Chest x-ray
| style="padding: 5px 5px; background: #F5F5F5;" align=center|Chest x-ray has no particular findings associated with cardiac myxoma
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
*Results can be normal
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
*Low cost
*May be helpful, if calcifications present
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
*Does not provide a diagnosis
|-
|}
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Latest revision as of 15:43, 29 October 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Overview

Other diagnostic study for cardiac myxoma includes cardiac angiography, which often demonstrates contrast media-enhanced tumor vasculature. [1]

Other Imaging Findings

Cardiac Angiography

The angiographic findings of cardiac myxoma demonstrate feeding vessels, contrast medium poolings, and clusters of tortuous vessels that correspond to tumor vasculature. In some cases, it is considered appropriate that older patients undergo coronary angiography to rule out the presence of ischemic heart diseases.[2]

Indications

  • Coronary angiography may be performed to detect vascular supply of the tumor by the coronary arteries.[3][4]


Imaging Technique Features Description Advantages Limitations
Two- or three-dimensional echocardiography Echocardiography is usually the initial modality used for identification and evaluation of cardiac myxomas.
  • Hyperechogenic lesions with a well-defined stalk
  • Protrusion into the ventricles is a common finding
  • Real-time imaging
  • Tumor mobility and distensibility
  • Limited views of the mediastinum and cannot be used to evaluate extracardiac manifestations of disease.[5]
  • TEE is an invasive imaging technique.
  • TT is limited by the imaging window, which can vary with the patient and operator experience.
MRI Evaluation of cardiac masses and is of greatest value when echocardiographic findings are suboptimal or when the lesion has an atypical location or appearance.
  • Cardiac myxomas appear spherical or ovoid with lobular contours, irregular in shape.
  • T1 : Low to intermediate signal, but areas of hemorrhage may be high.
  • T1 C+ (Gd): shows enhancement (important discriminator from a thrombus) demonstrates uniform heterogeneous enhancement.
  • MRI allows imaging in multiple planes
  • Provides some functional information such as, flow direction and flow velocity in large vessels
  • Cannot show calcification
  • High susceptibility to motion artifact.
  • Dependent on regular electrocardiographic rhythms and cardiac gating.
CT CT can be used to accurately image the heart and surrounding mediastinum
  • Intracardiac heterogeneously low attenuating mass
  • The attenuation is usually lower than that of myocardium
  • Calcification is common
  • CT provides better soft-tissue contrast
  • There is no real-time true imaging with CT and imaging planes are limited to those allowed by angulation of the gantry.
  • There is no evaluation of small moving structures, such as the cardiac valves.
Angiography Coronary angiography may be helpful to detect vascular supply of the tumor by the coronary arteries
  • The angiographic findings of cardiac myxoma demonstrate feeding vessels, contrast medium poolings, and clusters of tortuous vessels that correspond to tumor vasculature
  • Angiography can detect the concomitant coronary disease and the unique vascular appearances of cardiac myxoma
  • Helpful for surgical evaluation
  • Invasive imaging technique
Chest x-ray Chest x-ray has no particular findings associated with cardiac myxoma
  • Results can be normal
  • Low cost
  • May be helpful, if calcifications present
  • Does not provide a diagnosis

References

  1. ↑ Huang CY, Yu WC, Chen KC, Lin SJ (2005). "Coronary angiography of cardiac myxoma". Clin Cardiol. 28 (11): 505–9. PMID 16450793.
  2. ↑ Jelic J, Milicić D, Alfirević I, Anić D, Baudoin Z, Bulat C, Corić V, Dadić D, Husar J, Ivanćan V, Korda Z, Letica D, Predrijevac M, Ugljen R, Vućemilo I (1996). "Cardiac myxoma: diagnostic approach, surgical treatment and follow-up. A twenty years experience". J Cardiovasc Surg (Torino). 37 (6 Suppl 1): 113–7. PMID 10064362.
  3. ↑ Hasdemir H, Alper AT, Arslan Y, Erdinler I (2011). "[Left atrial myxoma with severe neovascularization: role of preoperative coronary angiography]". Turk Kardiyol Dern Ars (in Turkish). 39 (2): 163–5. doi:10.5543/tkda.2011.01284. PMID 21430425.
  4. ↑ Fueredi GA, Knechtges TE, Czarnecki DJ (1989). "Coronary angiography in atrial myxoma: findings in nine cases". AJR Am J Roentgenol. 152 (4): 737–8. doi:10.2214/ajr.152.4.737. PMID 2784254.
  5. ↑ Reeder GS, Khandheria BK, Seward JB, Tajik AJ (1991). "Transesophageal echocardiography and cardiac masses". Mayo Clin. Proc. 66 (11): 1101–9. PMID 1943240.


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