Cardiac tumors laboratory tests: Difference between revisions
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{{CMG}}; {{AE}} {{Dj}} | {{CMG}}; {{AE}} {{Dj}} | ||
==Overview== | ==Overview== | ||
Biopsy is required for definitive diagnosis, echocardiogram is a preliminary diagnosing tool for most cardiac tumors. Certain cardiac tumors release inflammatory cytokines which can lead to increased blood inflammatory markers like ESR, CRP. | |||
==Laboratory Findings== | ==Laboratory Findings== | ||
===Blood Investigations=== | ===Blood Investigations=== | ||
*Some patients with cardiac tumors may have [[anemia]], less commonly [[thrombocytopenia]], increases in [[sedimentation rate]], serum [[C-reactive protein]] level, or [[globulin]] level. These are nonspecific diagnostic anomalies.<ref name="pmid33040219">{{cite journal| author=Bussani R, Castrichini M, Restivo L, Fabris E, Porcari A, Ferro F | display-authors=etal| title=Cardiac Tumors: Diagnosis, Prognosis, and Treatment. | journal=Curr Cardiol Rep | year= 2020 | volume= 22 | issue= 12 | pages= 169 | pmid=33040219 | doi=10.1007/s11886-020-01420-z | pmc=7547967 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33040219 }} </ref><ref name="pmidhttps://pubmed.gov/11388092">{{cite journal| author=Pinede L, Duhaut P, Loire R| title=Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases. | journal=Medicine (Baltimore) | year= 2001 | volume= 80 | issue= 3 | pages= 159-72 | pmid=https://pubmed.gov/11388092 | doi=10.1097/00005792-200105000-00002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11388092 }} </ref> | *Some patients with cardiac tumors may have [[anemia]], less commonly [[thrombocytopenia]], increases in [[sedimentation rate]], serum [[C-reactive protein]] level, or [[globulin]] level. These are nonspecific diagnostic anomalies.<ref name="pmid33040219">{{cite journal| author=Bussani R, Castrichini M, Restivo L, Fabris E, Porcari A, Ferro F | display-authors=etal| title=Cardiac Tumors: Diagnosis, Prognosis, and Treatment. | journal=Curr Cardiol Rep | year= 2020 | volume= 22 | issue= 12 | pages= 169 | pmid=33040219 | doi=10.1007/s11886-020-01420-z | pmc=7547967 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=33040219 }} </ref><ref name="pmidhttps://pubmed.gov/11388092">{{cite journal| author=Pinede L, Duhaut P, Loire R| title=Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases. | journal=Medicine (Baltimore) | year= 2001 | volume= 80 | issue= 3 | pages= 159-72 | pmid=https://pubmed.gov/11388092 | doi=10.1097/00005792-200105000-00002 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11388092 }} </ref> | ||
*[[Antimyolemmal antibodies]] could also be elevated. Antimyolemmal antibodies are significantly more prevalent in chronic pericardial effusion, perimyocarditis, and dilated cardiomyopathy patients than healthy controls.<ref name="pmid26941472">{{cite journal| author=Karatolios K, Pankuweit S, Richter A, Ruppert V, Maisch B| title=Anticardiac Antibodies in Patients with Chronic Pericardial Effusion. | journal=Dis Markers | year= 2016 | volume= 2016 | issue= | pages= 9262741 | pmid=26941472 | doi=10.1155/2016/9262741 | pmc=4749782 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26941472 }} </ref> | *[[Antimyolemmal antibodies]] could also be elevated. Antimyolemmal antibodies are significantly more prevalent in chronic [[pericardial effusion]], [[perimyocarditis]], and [[dilated cardiomyopathy]] patients than healthy controls.<ref name="pmid26941472">{{cite journal| author=Karatolios K, Pankuweit S, Richter A, Ruppert V, Maisch B| title=Anticardiac Antibodies in Patients with Chronic Pericardial Effusion. | journal=Dis Markers | year= 2016 | volume= 2016 | issue= | pages= 9262741 | pmid=26941472 | doi=10.1155/2016/9262741 | pmc=4749782 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26941472 }} </ref> | ||
*[[Antiendothelial antibodies]] of the IgG type are detected in 86 percent of [[atrial myxoma]] patients. [[Endothelial cells]] are activated by Antiendothelial antibodies, leading to enhanced leukocyte adhesion, clotting activation, and vessel thrombosis.<ref name="pmid16569688">{{cite journal| author=Belizna C, Duijvestijn A, Hamidou M, Tervaert JW| title=Antiendothelial cell antibodies in vasculitis and connective tissue disease. | journal=Ann Rheum Dis | year= 2006 | volume= 65 | issue= 12 | pages= 1545-50 | pmid=16569688 | doi=10.1136/ard.2005.035295 | pmc=1798473 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16569688 }} </ref><ref name="pmid26941472">{{cite journal| author=Karatolios K, Pankuweit S, Richter A, Ruppert V, Maisch B| title=Anticardiac Antibodies in Patients with Chronic Pericardial Effusion. | journal=Dis Markers | year= 2016 | volume= 2016 | issue= | pages= 9262741 | pmid=26941472 | doi=10.1155/2016/9262741 | pmc=4749782 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26941472 }} </ref> | *[[Antiendothelial antibodies]] of the IgG type are detected in 86 percent of [[atrial myxoma]] patients. [[Endothelial cells]] are activated by Antiendothelial antibodies, leading to enhanced leukocyte adhesion, clotting activation, and vessel thrombosis.<ref name="pmid16569688">{{cite journal| author=Belizna C, Duijvestijn A, Hamidou M, Tervaert JW| title=Antiendothelial cell antibodies in vasculitis and connective tissue disease. | journal=Ann Rheum Dis | year= 2006 | volume= 65 | issue= 12 | pages= 1545-50 | pmid=16569688 | doi=10.1136/ard.2005.035295 | pmc=1798473 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16569688 }} </ref><ref name="pmid26941472">{{cite journal| author=Karatolios K, Pankuweit S, Richter A, Ruppert V, Maisch B| title=Anticardiac Antibodies in Patients with Chronic Pericardial Effusion. | journal=Dis Markers | year= 2016 | volume= 2016 | issue= | pages= 9262741 | pmid=26941472 | doi=10.1155/2016/9262741 | pmc=4749782 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26941472 }} </ref> | ||
===Imaging=== | ===Imaging=== | ||
*The '''CXR''' can detect cardiomegaly. A localized tumor prominence may or may not be present. | *The '''CXR''' can detect cardiomegaly. A localized tumor prominence may or may not be present. | ||
*On '''echocardiography''', a massive, noncontractile, firm lump may be observed in the atrial or ventricular walls. It is more useful in diagnosing myxomas as compared to sarcomas. | *On '''echocardiography''', a massive, noncontractile, firm lump may be observed in the atrial or ventricular walls. It is more useful in diagnosing myxomas as compared to sarcomas.<ref name="pmid12797518">{{cite journal| author=Gilkeson RC, Chiles C| title=MR evaluation of cardiac and pericardial malignancy. | journal=Magn Reson Imaging Clin N Am | year= 2003 | volume= 11 | issue= 1 | pages= 173-86, viii | pmid=12797518 | doi=10.1016/s1064-9689(02)00047-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12797518 }} </ref> | ||
*'''Doppler ultrasonography''' measures of velocities can be used to calculate chamber pressures. | *'''Doppler ultrasonography''' measures of velocities can be used to calculate chamber pressures.<ref name="pmid10555666">{{cite journal| author=Araoz PA, Eklund HE, Welch TJ, Breen JF| title=CT and MR imaging of primary cardiac malignancies. | journal=Radiographics | year= 1999 | volume= 19 | issue= 6 | pages= 1421-34 | pmid=10555666 | doi=10.1148/radiographics.19.6.g99no031421 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10555666 }} </ref> | ||
*'''Transesophageal echocardiography''' (TEE) is appropriate for evaluating malignancies anticipated to include the atria, interatrial septum, superior vena cava, atrioventricular valves, and, to a minor degree, the ventricles. | *'''Transesophageal echocardiography''' (TEE) is appropriate for evaluating malignancies anticipated to include the atria, interatrial septum, superior vena cava, atrioventricular valves, and, to a minor degree, the ventricles.<ref name="pmid12797518">{{cite journal| author=Gilkeson RC, Chiles C| title=MR evaluation of cardiac and pericardial malignancy. | journal=Magn Reson Imaging Clin N Am | year= 2003 | volume= 11 | issue= 1 | pages= 173-86, viii | pmid=12797518 | doi=10.1016/s1064-9689(02)00047-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12797518 }} </ref> | ||
*'''CT and Cardiac MRI'''(CMR)are helpful for resectability evaluation. | *'''CT and Cardiac MRI'''(CMR)are helpful for resectability evaluation.<ref name="pmid12797518">{{cite journal| author=Gilkeson RC, Chiles C| title=MR evaluation of cardiac and pericardial malignancy. | journal=Magn Reson Imaging Clin N Am | year= 2003 | volume= 11 | issue= 1 | pages= 173-86, viii | pmid=12797518 | doi=10.1016/s1064-9689(02)00047-8 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12797518 }} </ref> | ||
*'''PET''' can be utilized to detect cardiovascular spread in patients with metastatic malignancies and enables surgical treatment. | *'''PET''' can be utilized to detect cardiovascular spread in patients with metastatic malignancies and enables surgical treatment.<ref name="pmid16632427">{{cite journal| author=García JR, Simo M, Huguet M, Ysamat M, Lomeña F| title=Usefulness of 18-fluorodeoxyglucose positron emission tomography in the evaluation of tumor cardiac thrombus from renal cell carcinoma. | journal=Clin Transl Oncol | year= 2006 | volume= 8 | issue= 2 | pages= 124-8 | pmid=16632427 | doi=10.1007/s12094-006-0169-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16632427 }} </ref> | ||
**Imaging tests individually cannot determine if a heart tumor is benign or malignant; histologic assessment is required for a definite diagnosis. | **Imaging tests individually cannot determine if a heart tumor is benign or malignant; histologic assessment is required for a definite diagnosis. | ||
===Biopsy=== | |||
*Biopsy provides the definitive diagnosis and can be performed either as a: | |||
*Minimally invasive techniques such as | |||
**[[cytologic assessment]] of pericardial/pleural fluids, | |||
**echo-guided percutaneous cardiac biopsy, and | |||
**echo-guided transvenous cardiac biopsy can be used to diagnose tissue. | |||
*Or, [[mediastinoscopy]] or [[thoracotomy]] for more invasive tumor biopsies for a '''definitive diagnosis'''.<ref name="pmid22447042">{{cite journal| author=Lamba G, Frishman WH| title=Cardiac and pericardial tumors. | journal=Cardiol Rev | year= 2012 | volume= 20 | issue= 5 | pages= 237-52 | pmid=22447042 | doi=10.1097/CRD.0b013e31825603e7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22447042 }} </ref> | |||
*The false-negative rate of Minimally Invasive techniques can be substantially high.<ref name="pmid22447042">{{cite journal| author=Lamba G, Frishman WH| title=Cardiac and pericardial tumors. | journal=Cardiol Rev | year= 2012 | volume= 20 | issue= 5 | pages= 237-52 | pmid=22447042 | doi=10.1097/CRD.0b013e31825603e7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22447042 }} </ref> | |||
==References== | ==References== | ||
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{{WS}} | {{WS}} | ||
[[Category: | [[Category:needs english review]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Cardiology]] | [[Category:Cardiology]] | ||
Latest revision as of 20:19, 4 July 2022
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Template:Dj
Overview
Biopsy is required for definitive diagnosis, echocardiogram is a preliminary diagnosing tool for most cardiac tumors. Certain cardiac tumors release inflammatory cytokines which can lead to increased blood inflammatory markers like ESR, CRP.
Laboratory Findings
Blood Investigations
- Some patients with cardiac tumors may have anemia, less commonly thrombocytopenia, increases in sedimentation rate, serum C-reactive protein level, or globulin level. These are nonspecific diagnostic anomalies.[1][2]
- Antimyolemmal antibodies could also be elevated. Antimyolemmal antibodies are significantly more prevalent in chronic pericardial effusion, perimyocarditis, and dilated cardiomyopathy patients than healthy controls.[3]
- Antiendothelial antibodies of the IgG type are detected in 86 percent of atrial myxoma patients. Endothelial cells are activated by Antiendothelial antibodies, leading to enhanced leukocyte adhesion, clotting activation, and vessel thrombosis.[4][3]
Imaging
- The CXR can detect cardiomegaly. A localized tumor prominence may or may not be present.
- On echocardiography, a massive, noncontractile, firm lump may be observed in the atrial or ventricular walls. It is more useful in diagnosing myxomas as compared to sarcomas.[5]
- Doppler ultrasonography measures of velocities can be used to calculate chamber pressures.[6]
- Transesophageal echocardiography (TEE) is appropriate for evaluating malignancies anticipated to include the atria, interatrial septum, superior vena cava, atrioventricular valves, and, to a minor degree, the ventricles.[5]
- CT and Cardiac MRI(CMR)are helpful for resectability evaluation.[5]
- PET can be utilized to detect cardiovascular spread in patients with metastatic malignancies and enables surgical treatment.[7]
- Imaging tests individually cannot determine if a heart tumor is benign or malignant; histologic assessment is required for a definite diagnosis.
Biopsy
- Biopsy provides the definitive diagnosis and can be performed either as a:
- Minimally invasive techniques such as
- cytologic assessment of pericardial/pleural fluids,
- echo-guided percutaneous cardiac biopsy, and
- echo-guided transvenous cardiac biopsy can be used to diagnose tissue.
- Or, mediastinoscopy or thoracotomy for more invasive tumor biopsies for a definitive diagnosis.[8]
- The false-negative rate of Minimally Invasive techniques can be substantially high.[8]
References
- ↑ Bussani R, Castrichini M, Restivo L, Fabris E, Porcari A, Ferro F; et al. (2020). "Cardiac Tumors: Diagnosis, Prognosis, and Treatment". Curr Cardiol Rep. 22 (12): 169. doi:10.1007/s11886-020-01420-z. PMC 7547967 Check
|pmc=value (help). PMID 33040219 Check|pmid=value (help). - ↑ Pinede L, Duhaut P, Loire R (2001). "Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases". Medicine (Baltimore). 80 (3): 159–72. doi:10.1097/00005792-200105000-00002. PMID https://pubmed.gov/11388092 Check
|pmid=value (help). - ↑ 3.0 3.1 Karatolios K, Pankuweit S, Richter A, Ruppert V, Maisch B (2016). "Anticardiac Antibodies in Patients with Chronic Pericardial Effusion". Dis Markers. 2016: 9262741. doi:10.1155/2016/9262741. PMC 4749782. PMID 26941472.
- ↑ Belizna C, Duijvestijn A, Hamidou M, Tervaert JW (2006). "Antiendothelial cell antibodies in vasculitis and connective tissue disease". Ann Rheum Dis. 65 (12): 1545–50. doi:10.1136/ard.2005.035295. PMC 1798473. PMID 16569688.
- ↑ 5.0 5.1 5.2 Gilkeson RC, Chiles C (2003). "MR evaluation of cardiac and pericardial malignancy". Magn Reson Imaging Clin N Am. 11 (1): 173–86, viii. doi:10.1016/s1064-9689(02)00047-8. PMID 12797518.
- ↑ Araoz PA, Eklund HE, Welch TJ, Breen JF (1999). "CT and MR imaging of primary cardiac malignancies". Radiographics. 19 (6): 1421–34. doi:10.1148/radiographics.19.6.g99no031421. PMID 10555666.
- ↑ García JR, Simo M, Huguet M, Ysamat M, Lomeña F (2006). "Usefulness of 18-fluorodeoxyglucose positron emission tomography in the evaluation of tumor cardiac thrombus from renal cell carcinoma". Clin Transl Oncol. 8 (2): 124–8. doi:10.1007/s12094-006-0169-7. PMID 16632427.
- ↑ 8.0 8.1 Lamba G, Frishman WH (2012). "Cardiac and pericardial tumors". Cardiol Rev. 20 (5): 237–52. doi:10.1097/CRD.0b013e31825603e7. PMID 22447042.