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{{CMG}} ; {{AE}} {{ | {{Cardiac tumors}} | ||
{{CMG}} ; {{AE}} {{DMakkar}} | |||
==Overview== | |||
==Diagnostic Study of Choice== | |||
Multiple cardiovascular imaging modalities could be used to outline the structure of heart mass and its potential implications on the function. | Multiple cardiovascular imaging modalities could be used to outline the structure of heart mass and its potential implications on the function. | ||
*The primary objective of cardiovascular imaging is to define the location, extent, and vascularity of the tumor and to determine any hemodynamic effects, tumor and evaluate for invasion into myopericardium. | *The primary objective of cardiovascular imaging is to define the location, extent, and vascularity of the tumor and to determine any hemodynamic effects, tumor and evaluate for invasion into myopericardium. | ||
*All patients should undergo [[transthoracic echocardiography]] (TTE) in 2D. | *All patients should undergo [[transthoracic echocardiography]] (TTE) in 2D. | ||
*'''Contrast echocardiography''' permits the evaluation of tumor vasculature and hence facilitates the distinction between vascular malignancies and avascular tumors or thrombus.<ref name="pmid22805540">{{cite journal| author=Bhattacharyya S, Khattar R, Senior R| title=Characterisation of intra-cardiac masses by myocardial contrast echocardiography. | journal=Int J Cardiol | year= 2013 | volume= 163 | issue= 1 | pages= e11-3 | pmid=22805540 | doi=10.1016/j.ijcard.2012.06.098 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22805540 }} </ref> | *'''[[Contrast echocardiography]]''' permits the evaluation of tumor vasculature and hence facilitates the distinction between vascular malignancies and avascular tumors or thrombus.<ref name="pmid22805540">{{cite journal| author=Bhattacharyya S, Khattar R, Senior R| title=Characterisation of intra-cardiac masses by myocardial contrast echocardiography. | journal=Int J Cardiol | year= 2013 | volume= 163 | issue= 1 | pages= e11-3 | pmid=22805540 | doi=10.1016/j.ijcard.2012.06.098 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22805540 }} </ref> | ||
*'''Transesophageal echocardiography''' is particularly beneficial for visualizing atria-based malignancies when the exact location of attachment cannot be determined using transthoracic echocardiography (TTE) and evaluating their connection to the venae cavae.<ref name="pmid8922046">{{cite journal| author=Geibel A, Kasper W, Keck A, Hofmann T, Konstantinides S, Just H| title=Diagnosis, localization and evaluation of malignancy of heart and mediastinal tumors by conventional and transesophageal echocardiography. | journal=Acta Cardiol | year= 1996 | volume= 51 | issue= 5 | pages= 395-408 | pmid=8922046 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8922046 }} </ref> | *'''[[Transesophageal echocardiography]]''' is particularly beneficial for visualizing atria-based malignancies when the exact location of attachment cannot be determined using transthoracic echocardiography (TTE) and evaluating their connection to the venae cavae.<ref name="pmid8922046">{{cite journal| author=Geibel A, Kasper W, Keck A, Hofmann T, Konstantinides S, Just H| title=Diagnosis, localization and evaluation of malignancy of heart and mediastinal tumors by conventional and transesophageal echocardiography. | journal=Acta Cardiol | year= 1996 | volume= 51 | issue= 5 | pages= 395-408 | pmid=8922046 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8922046 }} </ref> | ||
*'''Cardiac MRI''' sequencing can be utilized to determine the tumor's fat, water, vasculature, and ferrous content. | *'''[[Cardiac MRI]]''' sequencing can be utilized to determine the tumor's fat, water, vasculature, and ferrous content. | ||
In secondary cardiac tumors, ''' | In secondary cardiac tumors, '''[[Computed tomography (CT)]]''' may be useful for screening prospective primary tumor locations in the chest, abdomen, and pelvis.<ref name="pmid14516903">{{cite journal| author=Hoffmann U, Globits S, Schima W, Loewe C, Puig S, Oberhuber G | display-authors=etal| title=Usefulness of magnetic resonance imaging of cardiac and paracardiac masses. | journal=Am J Cardiol | year= 2003 | volume= 92 | issue= 7 | pages= 890-5 | pmid=14516903 | doi=10.1016/s0002-9149(03)00911-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14516903 }} </ref> | ||
'''Biopsy''' gives the ultimate diagnosis. Percutaneous cardiac biopsy and transvenous cardiac biopsy, guided by echocardiography, mediastinoscopy, or thoracotomy, are used to carry out the procedure for a definitive diagnosis. | |||
===Take home points=== | |||
*Echocardiography continues to be the '''best first''' imaging technique for identifying cardiac/pericardial malignancies. | |||
*Cardiac MRI is the '''best non-invasive''' technique; gives supplementary information for tissue characterization, and evaluation of myocardial infiltration. | |||
*CT is essential to determine the presence of extracardiac metastatic dissemination. | |||
*The precise combination of imaging modalities should be individualized for each patient. Histopathological analysis of any excised cardiac mass is the '''diagnostic gold standard'''. It enables the determination of benign or malignant origin and accurate histotype.<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> | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Up to Date]] | |||
Latest revision as of 16:31, 14 July 2022
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Dheeraj Makkar, M.D.[2]
Overview
Diagnostic Study of Choice
Multiple cardiovascular imaging modalities could be used to outline the structure of heart mass and its potential implications on the function.
- The primary objective of cardiovascular imaging is to define the location, extent, and vascularity of the tumor and to determine any hemodynamic effects, tumor and evaluate for invasion into myopericardium.
- All patients should undergo transthoracic echocardiography (TTE) in 2D.
- Contrast echocardiography permits the evaluation of tumor vasculature and hence facilitates the distinction between vascular malignancies and avascular tumors or thrombus.[1]
- Transesophageal echocardiography is particularly beneficial for visualizing atria-based malignancies when the exact location of attachment cannot be determined using transthoracic echocardiography (TTE) and evaluating their connection to the venae cavae.[2]
- Cardiac MRI sequencing can be utilized to determine the tumor's fat, water, vasculature, and ferrous content.
In secondary cardiac tumors, Computed tomography (CT) may be useful for screening prospective primary tumor locations in the chest, abdomen, and pelvis.[3]
Biopsy gives the ultimate diagnosis. Percutaneous cardiac biopsy and transvenous cardiac biopsy, guided by echocardiography, mediastinoscopy, or thoracotomy, are used to carry out the procedure for a definitive diagnosis.
Take home points
- Echocardiography continues to be the best first imaging technique for identifying cardiac/pericardial malignancies.
- Cardiac MRI is the best non-invasive technique; gives supplementary information for tissue characterization, and evaluation of myocardial infiltration.
- CT is essential to determine the presence of extracardiac metastatic dissemination.
- The precise combination of imaging modalities should be individualized for each patient. Histopathological analysis of any excised cardiac mass is the diagnostic gold standard. It enables the determination of benign or malignant origin and accurate histotype.[4]
References
- ↑ Bhattacharyya S, Khattar R, Senior R (2013). "Characterisation of intra-cardiac masses by myocardial contrast echocardiography". Int J Cardiol. 163 (1): e11–3. doi:10.1016/j.ijcard.2012.06.098. PMID 22805540.
- ↑ Geibel A, Kasper W, Keck A, Hofmann T, Konstantinides S, Just H (1996). "Diagnosis, localization and evaluation of malignancy of heart and mediastinal tumors by conventional and transesophageal echocardiography". Acta Cardiol. 51 (5): 395–408. PMID 8922046.
- ↑ Hoffmann U, Globits S, Schima W, Loewe C, Puig S, Oberhuber G; et al. (2003). "Usefulness of magnetic resonance imaging of cardiac and paracardiac masses". Am J Cardiol. 92 (7): 890–5. doi:10.1016/s0002-9149(03)00911-1. PMID 14516903.
- ↑ 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).