Myxoma differential diagnosis: Difference between revisions

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==Overview==
==Overview==


Cardiac myxoma should be differentiated from other benign and malignant primary heart tumors including [[papillary fibroelastoma]], [[lipoma]], [[rhabdomyoma]], and cardiac [[metastasis]]. Primarily,  cardiac myxoma should be differentiated from other diseases that cause [[mitral valve]] obstruction and [[embolic]] events, such as [[thrombi]] or [[endocarditis]].<ref name="pmid24599357">{{cite journal |vauthors=Hartig I, Kraatz EG, Beurich HW, Moosig F |title=[Atrial myxoma with clinical signs of systemic inflammatory disease.] |journal=Z Rheumatol |volume= |issue= |pages= |year=2014 |pmid=24599357 |doi=10.1007/s00393-013-1347-y |url=}}</ref>
Cardiac myxoma should be differentiated from other benign and malignant primary heart tumors including [[papillary fibroelastoma]], [[lipoma]], [[rhabdomyoma]], and cardiac [[metastasis]]. Primarily,  cardiac myxoma should be differentiated from other diseases that cause [[mitral valve]] obstruction and [[embolic]] events, such as [[thrombi]] or [[endocarditis]].


==Differentiating Myxoma from other Diseases==
==Differentiating Myxoma from other Diseases==
Cardiac myxoma should be differentiated from other cardiac tumors that present as a cardiac mass. The following are the differentials:<ref name="pmid27600455">{{cite journal |vauthors=Mankad R, Herrmann J |title=Cardiac tumors: echo assessment |journal=Echo Res Pract |volume=3 |issue=4 |pages=R65–R77 |date=December 2016 |pmid=27600455 |pmc=5292983 |doi=10.1530/ERP-16-0035 |url=}}</ref><ref name="pmid22283202">{{cite journal |vauthors=Zaragoza-Macias E, Zaragosa-Macias E, Chen MA, Gill EA |title=Real time three-dimensional echocardiography evaluation of intracardiac masses |journal=Echocardiography |volume=29 |issue=2 |pages=207–19 |date=February 2012 |pmid=22283202 |doi=10.1111/j.1540-8175.2011.01627.x |url=}}</ref><ref name="pmid7062746">{{cite journal |vauthors=Larrieu AJ, Jamieson WR, Tyers GF, Burr LH, Munro AI, Miyagishima RT, Gerein AN, Allen P |title=Primary cardiac tumors: experience with 25 cases |journal=J. Thorac. Cardiovasc. Surg. |volume=83 |issue=3 |pages=339–48 |date=March 1982 |pmid=7062746 |doi= |url=}}</ref><ref name="pmid2237900">{{cite journal |vauthors=Molina JE, Edwards JE, Ward HB |title=Primary cardiac tumors: experience at the University of Minnesota |journal=Thorac Cardiovasc Surg |volume=38 Suppl 2 |issue= |pages=183–91 |date=August 1990 |pmid=2237900 |doi=10.1055/s-2007-1014064 |url=}}</ref><ref name="pmid1434856">{{cite journal |vauthors=Tazelaar HD, Locke TJ, McGregor CG |title=Pathology of surgically excised primary cardiac tumors |journal=Mayo Clin. Proc. |volume=67 |issue=10 |pages=957–65 |date=October 1992 |pmid=1434856 |doi= |url=}}</ref><ref name="pmid14728061">{{cite journal |vauthors=Sarjeant JM, Butany J, Cusimano RJ |title=Cancer of the heart: epidemiology and management of primary tumors and metastases |journal=Am J Cardiovasc Drugs |volume=3 |issue=6 |pages=407–21 |date=2003 |pmid=14728061 |doi=10.2165/00129784-200303060-00004 |url=}}</ref><ref name="pmid7382545">{{cite journal |vauthors=St John Sutton MG, Mercier LA, Giuliani ER, Lie JT |title=Atrial myxomas: a review of clinical experience in 40 patients |journal=Mayo Clin. Proc. |volume=55 |issue=6 |pages=371–6 |date=June 1980 |pmid=7382545 |doi= |url=}}</ref><ref name="pmid11388092">{{cite journal |vauthors=Pinede L, Duhaut P, Loire R |title=Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases |journal=Medicine (Baltimore) |volume=80 |issue=3 |pages=159–72 |date=May 2001 |pmid=11388092 |doi= |url=}}</ref><ref name="pmid7477198">{{cite journal |vauthors=Reynen K |title=Cardiac myxomas |journal=N. Engl. J. Med. |volume=333 |issue=24 |pages=1610–7 |date=December 1995 |pmid=7477198 |doi=10.1056/NEJM199512143332407 |url=}}</ref><ref name="pmid24642215">{{cite journal |vauthors=Javed A, Zalawadiya S, Kovach J, Afonso L |title=Aortic valve myxoma at the extreme age: a review of literature |journal=BMJ Case Rep |volume=2014 |issue= |pages= |date=March 2014 |pmid=24642215 |pmc=3962858 |doi=10.1136/bcr-2013-202689 |url=}}</ref><ref name="pmid17698701">{{cite journal |vauthors=Lee VH, Connolly HM, Brown RD |title=Central nervous system manifestations of cardiac myxoma |journal=Arch. Neurol. |volume=64 |issue=8 |pages=1115–20 |date=August 2007 |pmid=17698701 |doi=10.1001/archneur.64.8.1115 |url=}}</ref><ref name="pmid4010501">{{cite journal |vauthors=Carney JA, Gordon H, Carpenter PC, Shenoy BV, Go VL |title=The complex of myxomas, spotty pigmentation, and endocrine overactivity |journal=Medicine (Baltimore) |volume=64 |issue=4 |pages=270–83 |date=July 1985 |pmid=4010501 |doi= |url=}}</ref><ref name="pmid10028128">{{cite journal |vauthors=McAllister HA, Hall RJ, Cooley DA |title=Tumors of the heart and pericardium |journal=Curr Probl Cardiol |volume=24 |issue=2 |pages=57–116 |date=February 1999 |pmid=10028128 |doi= |url=}}</ref><ref name="pmid9283541">{{cite journal |vauthors=Klarich KW, Enriquez-Sarano M, Gura GM, Edwards WD, Tajik AJ, Seward JB |title=Papillary fibroelastoma: echocardiographic characteristics for diagnosis and pathologic correlation |journal=J. Am. Coll. Cardiol. |volume=30 |issue=3 |pages=784–90 |date=September 1997 |pmid=9283541 |doi= |url=}}</ref><ref name="pmid26046736">{{cite journal |vauthors=Tamin SS, Maleszewski JJ, Scott CG, Khan SK, Edwards WD, Bruce CJ, Oh JK, Pellikka PA, Klarich KW |title=Prognostic and Bioepidemiologic Implications of Papillary Fibroelastomas |journal=J. Am. Coll. Cardiol. |volume=65 |issue=22 |pages=2420–9 |date=June 2015 |pmid=26046736 |doi=10.1016/j.jacc.2015.03.569 |url=}}</ref><ref name="pmid12947356">{{cite journal |vauthors=Gowda RM, Khan IA, Nair CK, Mehta NJ, Vasavada BC, Sacchi TJ |title=Cardiac papillary fibroelastoma: a comprehensive analysis of 725 cases |journal=Am. Heart J. |volume=146 |issue=3 |pages=404–10 |date=September 2003 |pmid=12947356 |doi=10.1016/S0002-8703(03)00249-7 |url=}}</ref><ref name="pmid9424072">{{cite journal |vauthors=Beghetti M, Gow RM, Haney I, Mawson J, Williams WG, Freedom RM |title=Pediatric primary benign cardiac tumors: a 15-year review |journal=Am. Heart J. |volume=134 |issue=6 |pages=1107–14 |date=December 1997 |pmid=9424072 |doi= |url=}}</ref><ref name="pmid2239731">{{cite journal |vauthors=Smythe JF, Dyck JD, Smallhorn JF, Freedom RM |title=Natural history of cardiac rhabdomyoma in infancy and childhood |journal=Am. J. Cardiol. |volume=66 |issue=17 |pages=1247–9 |date=November 1990 |pmid=2239731 |doi= |url=}}</ref><ref name="pmid7979700">{{cite journal |vauthors=Jacobs JP, Konstantakos AK, Holland FW, Herskowitz K, Ferrer PL, Perryman RA |title=Surgical treatment for cardiac rhabdomyomas in children |journal=Ann. Thorac. Surg. |volume=58 |issue=5 |pages=1552–5 |date=November 1994 |pmid=7979700 |doi= |url=}}</ref><ref name="pmid18824772">{{cite journal |vauthors=Elbardissi AW, Dearani JA, Daly RC, Mullany CJ, Orszulak TA, Puga FJ, Schaff HV |title=Survival after resection of primary cardiac tumors: a 48-year experience |journal=Circulation |volume=118 |issue=14 Suppl |pages=S7–15 |date=September 2008 |pmid=18824772 |doi=10.1161/CIRCULATIONAHA.107.783126 |url=}}</ref><ref name="pmid8049952">{{cite journal |vauthors=Basu S, Folliguet T, Anselmo M, Greengart A, Sabado M, Cunningham JN, Jacobowitz IJ |title=Lipomatous hypertrophy of the interatrial septum |journal=Cardiovasc Surg |volume=2 |issue=2 |pages=229–31 |date=April 1994 |pmid=8049952 |doi= |url=}}</ref><ref name="pmid18428209">{{cite journal |vauthors=Simpson L, Kumar SK, Okuno SH, Schaff HV, Porrata LF, Buckner JC, Moynihan TJ |title=Malignant primary cardiac tumors: review of a single institution experience |journal=Cancer |volume=112 |issue=11 |pages=2440–6 |date=June 2008 |pmid=18428209 |doi=10.1002/cncr.23459 |url=}}</ref><ref name="pmid10807431">{{cite journal |vauthors=Vander Salm TJ |title=Unusual primary tumors of the heart |journal=Semin. Thorac. Cardiovasc. Surg. |volume=12 |issue=2 |pages=89–100 |date=April 2000 |pmid=10807431 |doi= |url=}}</ref><ref name="pmid1008078">{{cite journal |vauthors=Petersen CD, Robinson WA, Kurnick JE |title=Involvement of the heart and pericardium in the malignant lymphomas |journal=Am. J. Med. Sci. |volume=272 |issue=2 |pages=161–5 |date=1976 |pmid=1008078 |doi= |url=}}</ref><ref name="pmid16595790">{{cite journal |vauthors=Ragland MM, Tak T |title=The role of echocardiography in diagnosing space-occupying lesions of the heart |journal=Clin Med Res |volume=4 |issue=1 |pages=22–32 |date=March 2006 |pmid=16595790 |pmc=1447535 |doi= |url=}}</ref><ref name="pmid20227122">{{cite journal |vauthors=Miguel CE, Bestetti RB |title=Primary cardiac lymphoma |journal=Int. J. Cardiol. |volume=149 |issue=3 |pages=358–63 |date=June 2011 |pmid=20227122 |doi=10.1016/j.ijcard.2010.02.016 |url=}}</ref><ref name="pmid10903697">{{cite journal |vauthors=Grebenc ML, Rosado de Christenson ML, Burke AP, Green CE, Galvin JR |title=Primary cardiac and pericardial neoplasms: radiologic-pathologic correlation |journal=Radiographics |volume=20 |issue=4 |pages=1073–103; quiz 1110–1, 1112 |date=2000 |pmid=10903697 |doi=10.1148/radiographics.20.4.g00jl081073 |url=}}</ref><ref name="pmid9869763">{{cite journal |vauthors=Grinda JM, Couetil JP, Chauvaud S, D'Attellis N, Berrebi A, Fabiani JN, Deloche A, Carpentier A |title=Cardiac valve papillary fibroelastoma: surgical excision for revealed or potential embolization |journal=J. Thorac. Cardiovasc. Surg. |volume=117 |issue=1 |pages=106–10 |date=January 1999 |pmid=9869763 |doi= |url=}}</ref><ref name="pmid8466239">{{cite journal |vauthors=Webb DW, Thomas RD, Osborne JP |title=Cardiac rhabdomyomas and their association with tuberous sclerosis |journal=Arch. Dis. Child. |volume=68 |issue=3 |pages=367–70 |date=March 1993 |pmid=8466239 |pmc=1793857 |doi= |url=}}</ref><ref name="pmid19493870">{{cite journal |vauthors=Yoshitake I, Hata M, Sezai A, Niino T, Unosawa S, Shimura K, Kasamaki Y, Minami K |title=Cardiac angiosarcoma with cardiac tamponade diagnosed as a ruptured aneurysm of the sinus valsalva |journal=Jpn. J. Clin. Oncol. |volume=39 |issue=9 |pages=612–5 |date=September 2009 |pmid=19493870 |doi=10.1093/jjco/hyp044 |url=}}</ref><ref name="pmid20939891">{{cite journal |vauthors=Parissis H, Akbar MT, Young V |title=Primary leiomyosarcoma of the right atrium: a case report and literature update |journal=J Cardiothorac Surg |volume=5 |issue= |pages=80 |date=October 2010 |pmid=20939891 |pmc=2964688 |doi=10.1186/1749-8090-5-80 |url=}}</ref><ref name="pmid15383848">{{cite journal |vauthors=Gulati G, Sharma S, Kothari SS, Juneja R, Saxena A, Talwar KK |title=Comparison of echo and MRI in the imaging evaluation of intracardiac masses |journal=Cardiovasc Intervent Radiol |volume=27 |issue=5 |pages=459–69 |date=2004 |pmid=15383848 |doi=10.1007/s00270-004-0123-4 |url=}}</ref><ref name="pmid20150010">{{cite journal |vauthors=Narin B, Arman A, Arslan D, Simşek M, Narin A |title=Assessment of cardiac masses: magnetic resonance imaging versus transthoracic echocardiography |journal=Anadolu Kardiyol Derg |volume=10 |issue=1 |pages=69–74 |date=February 2010 |pmid=20150010 |doi= |url=}}</ref><ref name="urlacademic.oup.com">{{cite web |url=https://academic.oup.com/ehjcimaging/article/8/6/487/2398147 |title=academic.oup.com |format= |work= |accessdate=}}</ref><ref name="pmid26486106">{{cite journal |vauthors=Ismail I, Al-Khafaji K, Mutyala M, Aggarwal S, Cotter W, Hakim H, Khosla S, Arora R |title=Cardiac lipoma |journal=J Community Hosp Intern Med Perspect |volume=5 |issue=5 |pages=28449 |date=2015 |pmid=26486106 |pmc=4612478 |doi=10.3402/jchimp.v5.28449 |url=}}</ref><ref name="pmid28088193">{{cite journal |vauthors=D'Souza J, Shah R, Abbass A, Burt JR, Goud A, Dahagam C |title=Invasive Cardiac Lipoma: a case report and review of literature |journal=BMC Cardiovasc Disord |volume=17 |issue=1 |pages=28 |date=January 2017 |pmid=28088193 |pmc=5237479 |doi=10.1186/s12872-016-0465-2 |url=}}</ref><ref name="YadavBaquero2014">{{cite journal|last1=Yadav|first1=Pradeep K.|last2=Baquero|first2=Giselle A.|last3=Malysz|first3=Jozef|last4=Kelleman|first4=John|last5=Gilchrist|first5=Ian C.|title=Cardiac Paraganglioma|journal=Circulation: Cardiovascular Interventions|volume=7|issue=6|year=2014|pages=851–856|issn=1941-7640|doi=10.1161/CIRCINTERVENTIONS.114.001856}}</ref><ref name="pmid20069088">{{cite journal |vauthors=Tahir M, Noor SJ, Herle A, Downing S |title=Right atrial paraganglioma: a rare primary cardiac neoplasm as a cause of chest pain |journal=Tex Heart Inst J |volume=36 |issue=6 |pages=594–7 |date=2009 |pmid=20069088 |pmc=2801953 |doi= |url=}}</ref><ref name="pmid89769312">{{cite journal |vauthors=Hamilton BH, Francis IR, Gross BH, Korobkin M, Shapiro B, Shulkin BL, Deeb CM, Orringer MB |title=Intrapericardial paragangliomas (pheochromocytomas): imaging features |journal=AJR Am J Roentgenol |volume=168 |issue=1 |pages=109–13 |date=January 1997 |pmid=8976931 |doi=10.2214/ajr.168.1.8976931 |url=}}</ref><ref name="ShihMcCullough1993">{{cite journal|last1=Shih|first1=Wei-Jen|last2=McCullough|first2=Scott|last3=Smith|first3=Mary|title=Diagnostic imagings for primary cardiac fibrosarcoma|journal=International Journal of Cardiology|volume=39|issue=2|year=1993|pages=157–161|issn=01675273|doi=10.1016/0167-5273(93)90028-F}}</ref><ref name="pmid9832064">{{cite journal |vauthors=Arai T, Kurashima C, Wada S, Chida K, Ohkawa S |title=Histological evidence for cell proliferation activity in cystic tumor (endodermal heterotopia) of the atrioventricular node |journal=Pathol. 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Cardiac myxoma should be differentiated from other cardiac tumors that present as a cardiac mass. The following are the differentials:<ref name="pmid24599357">{{cite journal |vauthors=Hartig I, Kraatz EG, Beurich HW, Moosig F |title=[Atrial myxoma with clinical signs of systemic inflammatory disease.] |journal=Z Rheumatol |volume= |issue= |pages= |year=2014 |pmid=24599357 |doi=10.1007/s00393-013-1347-y |url=}}</ref><ref name="pmid27600455">{{cite journal |vauthors=Mankad R, Herrmann J |title=Cardiac tumors: echo assessment |journal=Echo Res Pract |volume=3 |issue=4 |pages=R65–R77 |date=December 2016 |pmid=27600455 |pmc=5292983 |doi=10.1530/ERP-16-0035 |url=}}</ref><ref name="pmid22283202">{{cite journal |vauthors=Zaragoza-Macias E, Zaragosa-Macias E, Chen MA, Gill EA |title=Real time three-dimensional echocardiography evaluation of intracardiac masses |journal=Echocardiography |volume=29 |issue=2 |pages=207–19 |date=February 2012 |pmid=22283202 |doi=10.1111/j.1540-8175.2011.01627.x |url=}}</ref><ref name="pmid7062746">{{cite journal |vauthors=Larrieu AJ, Jamieson WR, Tyers GF, Burr LH, Munro AI, Miyagishima RT, Gerein AN, Allen P |title=Primary cardiac tumors: experience with 25 cases |journal=J. Thorac. Cardiovasc. Surg. |volume=83 |issue=3 |pages=339–48 |date=March 1982 |pmid=7062746 |doi= |url=}}</ref><ref name="pmid2237900">{{cite journal |vauthors=Molina JE, Edwards JE, Ward HB |title=Primary cardiac tumors: experience at the University of Minnesota |journal=Thorac Cardiovasc Surg |volume=38 Suppl 2 |issue= |pages=183–91 |date=August 1990 |pmid=2237900 |doi=10.1055/s-2007-1014064 |url=}}</ref><ref name="pmid1434856">{{cite journal |vauthors=Tazelaar HD, Locke TJ, McGregor CG |title=Pathology of surgically excised primary cardiac tumors |journal=Mayo Clin. Proc. |volume=67 |issue=10 |pages=957–65 |date=October 1992 |pmid=1434856 |doi= |url=}}</ref><ref name="pmid14728061">{{cite journal |vauthors=Sarjeant JM, Butany J, Cusimano RJ |title=Cancer of the heart: epidemiology and management of primary tumors and metastases |journal=Am J Cardiovasc Drugs |volume=3 |issue=6 |pages=407–21 |date=2003 |pmid=14728061 |doi=10.2165/00129784-200303060-00004 |url=}}</ref><ref name="pmid7382545">{{cite journal |vauthors=St John Sutton MG, Mercier LA, Giuliani ER, Lie JT |title=Atrial myxomas: a review of clinical experience in 40 patients |journal=Mayo Clin. Proc. |volume=55 |issue=6 |pages=371–6 |date=June 1980 |pmid=7382545 |doi= |url=}}</ref><ref name="pmid11388092">{{cite journal |vauthors=Pinede L, Duhaut P, Loire R |title=Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases |journal=Medicine (Baltimore) |volume=80 |issue=3 |pages=159–72 |date=May 2001 |pmid=11388092 |doi= |url=}}</ref><ref name="pmid7477198">{{cite journal |vauthors=Reynen K |title=Cardiac myxomas |journal=N. Engl. J. Med. |volume=333 |issue=24 |pages=1610–7 |date=December 1995 |pmid=7477198 |doi=10.1056/NEJM199512143332407 |url=}}</ref><ref name="pmid24642215">{{cite journal |vauthors=Javed A, Zalawadiya S, Kovach J, Afonso L |title=Aortic valve myxoma at the extreme age: a review of literature |journal=BMJ Case Rep |volume=2014 |issue= |pages= |date=March 2014 |pmid=24642215 |pmc=3962858 |doi=10.1136/bcr-2013-202689 |url=}}</ref><ref name="pmid17698701">{{cite journal |vauthors=Lee VH, Connolly HM, Brown RD |title=Central nervous system manifestations of cardiac myxoma |journal=Arch. Neurol. |volume=64 |issue=8 |pages=1115–20 |date=August 2007 |pmid=17698701 |doi=10.1001/archneur.64.8.1115 |url=}}</ref><ref name="pmid4010501">{{cite journal |vauthors=Carney JA, Gordon H, Carpenter PC, Shenoy BV, Go VL |title=The complex of myxomas, spotty pigmentation, and endocrine overactivity |journal=Medicine (Baltimore) |volume=64 |issue=4 |pages=270–83 |date=July 1985 |pmid=4010501 |doi= |url=}}</ref><ref name="pmid10028128">{{cite journal |vauthors=McAllister HA, Hall RJ, Cooley DA |title=Tumors of the heart and pericardium |journal=Curr Probl Cardiol |volume=24 |issue=2 |pages=57–116 |date=February 1999 |pmid=10028128 |doi= |url=}}</ref><ref name="pmid9283541">{{cite journal |vauthors=Klarich KW, Enriquez-Sarano M, Gura GM, Edwards WD, Tajik AJ, Seward JB |title=Papillary fibroelastoma: echocardiographic characteristics for diagnosis and pathologic correlation |journal=J. Am. Coll. Cardiol. |volume=30 |issue=3 |pages=784–90 |date=September 1997 |pmid=9283541 |doi= |url=}}</ref><ref name="pmid26046736">{{cite journal |vauthors=Tamin SS, Maleszewski JJ, Scott CG, Khan SK, Edwards WD, Bruce CJ, Oh JK, Pellikka PA, Klarich KW |title=Prognostic and Bioepidemiologic Implications of Papillary Fibroelastomas |journal=J. Am. Coll. Cardiol. |volume=65 |issue=22 |pages=2420–9 |date=June 2015 |pmid=26046736 |doi=10.1016/j.jacc.2015.03.569 |url=}}</ref><ref name="pmid12947356">{{cite journal |vauthors=Gowda RM, Khan IA, Nair CK, Mehta NJ, Vasavada BC, Sacchi TJ |title=Cardiac papillary fibroelastoma: a comprehensive analysis of 725 cases |journal=Am. Heart J. |volume=146 |issue=3 |pages=404–10 |date=September 2003 |pmid=12947356 |doi=10.1016/S0002-8703(03)00249-7 |url=}}</ref><ref name="pmid9424072">{{cite journal |vauthors=Beghetti M, Gow RM, Haney I, Mawson J, Williams WG, Freedom RM |title=Pediatric primary benign cardiac tumors: a 15-year review |journal=Am. Heart J. |volume=134 |issue=6 |pages=1107–14 |date=December 1997 |pmid=9424072 |doi= |url=}}</ref><ref name="pmid2239731">{{cite journal |vauthors=Smythe JF, Dyck JD, Smallhorn JF, Freedom RM |title=Natural history of cardiac rhabdomyoma in infancy and childhood |journal=Am. J. Cardiol. |volume=66 |issue=17 |pages=1247–9 |date=November 1990 |pmid=2239731 |doi= |url=}}</ref><ref name="pmid7979700">{{cite journal |vauthors=Jacobs JP, Konstantakos AK, Holland FW, Herskowitz K, Ferrer PL, Perryman RA |title=Surgical treatment for cardiac rhabdomyomas in children |journal=Ann. Thorac. Surg. |volume=58 |issue=5 |pages=1552–5 |date=November 1994 |pmid=7979700 |doi= |url=}}</ref><ref name="pmid18824772">{{cite journal |vauthors=Elbardissi AW, Dearani JA, Daly RC, Mullany CJ, Orszulak TA, Puga FJ, Schaff HV |title=Survival after resection of primary cardiac tumors: a 48-year experience |journal=Circulation |volume=118 |issue=14 Suppl |pages=S7–15 |date=September 2008 |pmid=18824772 |doi=10.1161/CIRCULATIONAHA.107.783126 |url=}}</ref><ref name="pmid8049952">{{cite journal |vauthors=Basu S, Folliguet T, Anselmo M, Greengart A, Sabado M, Cunningham JN, Jacobowitz IJ |title=Lipomatous hypertrophy of the interatrial septum |journal=Cardiovasc Surg |volume=2 |issue=2 |pages=229–31 |date=April 1994 |pmid=8049952 |doi= |url=}}</ref><ref name="pmid18428209">{{cite journal |vauthors=Simpson L, Kumar SK, Okuno SH, Schaff HV, Porrata LF, Buckner JC, Moynihan TJ |title=Malignant primary cardiac tumors: review of a single institution experience |journal=Cancer |volume=112 |issue=11 |pages=2440–6 |date=June 2008 |pmid=18428209 |doi=10.1002/cncr.23459 |url=}}</ref><ref name="pmid10807431">{{cite journal |vauthors=Vander Salm TJ |title=Unusual primary tumors of the heart |journal=Semin. 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Latest revision as of 19:31, 14 April 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]Cafer Zorkun, M.D., Ph.D. [3] Ahmad Al Maradni, M.D. [4] Maria Fernanda Villarreal, M.D. [5]

Overview

Cardiac myxoma should be differentiated from other benign and malignant primary heart tumors including papillary fibroelastoma, lipoma, rhabdomyoma, and cardiac metastasis. Primarily, cardiac myxoma should be differentiated from other diseases that cause mitral valve obstruction and embolic events, such as thrombi or endocarditis.

Differentiating Myxoma from other Diseases

Cardiac myxoma should be differentiated from other cardiac tumors that present as a cardiac mass. The following are the differentials:[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48]

Site of Tumor Malignant Potential Type of Tumor Tissue of Origin Age of Presentation Location Morphology Signs and Symptoms MRI Findings
Systemic Manifestations Cardiac Manifestations Embolic Manifestations
Primary Cardiac Tumor Primary Benign Myxoma
  • Between third to sixth decade of life
  • 1-15 cm in diameter
  • Pedunculated
  • Polypoid
  • Smooth and lobulated
  • Villous and pappillary appearance associated with embolization
Rhabdomyoma
  • Striated Muscle
  • 1-3 cm in size
  • Yellow-gray color
  • Firm
  • Circumscribed lobulated
  • Majority multiple if associated with tuberous sclerosis (of those with no association, 50% are single)
  • Multiple masses isointense to muscle tissue on T1 images
  • Hyperintense on T2 images
Fibroma
  • Children (1/3rd in infants)
  • Solitary
  • Solitary mass
  • Low intensity on T2 weighted image
Fibroelastoma
  • < 1 cm in diameter
  • Solitary
  • Papillary
  • Flower-like appearance with multiple attachments to valve
  • Short pedicle
  • T1 and T2 weighted images show uniform intermediate signal intensity similar to myocardium
  • Homogeneous late gadolinium contrast enhancement
Hemangioma
  • < 1 year to 70 years
  • < 2 % of primary cardiac tumors
  • Polypoid
  • Encapsulated
  • Intermediate density on T1 images
  • Hypointense on T2 images
  • Multicystic enhancing lesion
  • Involvement of epicardium or pericardium
Lipoma
  • Between fourth to sixth decade of life
  • Epicardial or intramural lesion
  • High intensity on T1 weighted image
  • Drop out on fat saturation images
Paraganglioma
  • Average age of presentation is 11-13 years
  • 3-8 cm
  • Well-defined
  • Broad base
  • Encapsulated
  • Heterogeneous
  • Hypervascular
Atrioventricular Node Tumor
  • Average age of diagnosis is 38 years
  • Female to male ratio 3:1
  • Hypointense cardiac mass on standard imaging
  • Hyperintensity on late gadolinium enhancement (LGE) images with heterogeneous contrast enhancement
Lipomatous hypertrophy of the interatrial septum
  • > 60 years
 -
Primary Malignant Fibrosarcoma
  • 20 to 80 years
  • Sessile or pedunculated protruding masses in ventricular cavities
  • Soft
  • Lobulated
  • Gelatinous
  • Heterogenous or isointense to myocardium on T1 weighted images
Angiosarcoma
  • 30 to 50 years
  • Arterial phase enhancement
Rhabdomyosarcoma
  • Most common primary sarcoma of children
  • Average age of presentation is 20 years
  • Multiple
  • Three types:
    • Embryonic
    • Pleomorphic
    • Alveolar
  • Intermediate-to-hypointensity compared with muscle on T1 images
  • Hyperintense on T2-weighted imaging with heterogeneous contrast enhancement
Lymphoma
  • 10 to 90 years
  • Males > females
  • Right sided mostly
  • Majority solitary (1/3rd multiple)
  • Hypointense on T1-weighted images and hyperintense on T2-weighted images
Secondary Cardiac Tumor Metastastatic Malignant Metastasis
  • Any age
  • Multiple


  • Differential diagnosis of intracardiac masses requires histological analysis and a direct assessment of the specific location (endocardial, myocardial, and pericardial). The table below summarizes the findings that differentiate cardiac myxoma from other conditions that are also intracavitary cardiac masses and cause embolic events:
Disease Findings
Papillary fibroelastoma Is a rare benign primary tumor of the heart that typically involves one of the valves of the heart. Presents with syncope, chest pain, myocardial infarction, stroke and sudden cardiac death. They are the third most common type of primary tumor of the heart. There is a slightly increased male predilection.[49][50]
Lipoma Also known as "Lipomatous hypertrophy (LHIS)" is a very rare benign primary cardiac neoplasm. It is the proliferation of mature adipocytes. Lipomas are typically found in adult patients but can affect all ages. A common clinical feature is arrythmias.[51]
Rhabdomyoma Is the most common primary cardiac tumor in children. It is conformed from hamartomatous accumulation of the striated cardiomyocytes. Rhabdomyomas occur with more frequency in the myocardium of the left ventricle or in the interventricular septum. Is commonly associated with tuberous sclerosis, and congenital defects of the heart.[52]
Thrombus Intracardiac thrombi, can occur when there is an elevated risk of blood clots developing, such as: atrial fibrillation (atrial thrombi predominate), mitral stenosis, heart valve replacement and myocardial infarction (ventricular thrombus formation).[53]
Metastasis Secondary malignant tumor of the heart, arising by lymphatic or hematogenous spread of a primary neoplasm. Presents with dyspnea, congestive heart failure, hypotension and malignant pericardial effusion. Any primary malignancy may metastasize to the heart, however, lung cancer is among the most common.[54]

References

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  2. ↑ Mankad R, Herrmann J (December 2016). "Cardiac tumors: echo assessment". Echo Res Pract. 3 (4): R65–R77. doi:10.1530/ERP-16-0035. PMC 5292983. PMID 27600455.
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  41. ↑ Shih, Wei-Jen; McCullough, Scott; Smith, Mary (1993). "Diagnostic imagings for primary cardiac fibrosarcoma". International Journal of Cardiology. 39 (2): 157–161. doi:10.1016/0167-5273(93)90028-F. ISSN 0167-5273.
  42. ↑ Arai T, Kurashima C, Wada S, Chida K, Ohkawa S (November 1998). "Histological evidence for cell proliferation activity in cystic tumor (endodermal heterotopia) of the atrioventricular node". Pathol. Int. 48 (11): 917–23. PMID 9832064.
  43. ↑ Wolf PL, Bing R (November 1965). "The smallest tumor which causes sudden death". JAMA. 194 (6): 674–5. PMID 5897246.
  44. ↑ Burke AP, Anderson PG, Virmani R, James TN, Herrera GA, Ceballos R (October 1990). "Tumor of the atrioventricular nodal region. A clinical and immunohistochemical study". Arch. Pathol. Lab. Med. 114 (10): 1057–62. PMID 2222148.
  45. ↑ Burke A, Tavora F (April 2016). "The 2015 WHO Classification of Tumors of the Heart and Pericardium". J Thorac Oncol. 11 (4): 441–52. doi:10.1016/j.jtho.2015.11.009. PMID 26725181.
  46. ↑ Tran, Thao T; Starnes, Vaughn; Wang, Xuedong; Getzen, James; Ross, Brian D (2009). "Cardiovascular magnetics resonance diagnosis of cystic tumor of the atrioventricular node". Journal of Cardiovascular Magnetic Resonance. 11 (1): 13. doi:10.1186/1532-429X-11-13. ISSN 1532-429X.
  47. ↑ Tatli, Servet; O'Gara, Patrick Thomas; Lambert, Jarvis; Kwong, Raymond; Byrne, John Gerald; Yucel, E. Kent (2004). "MRI of Atypical Lipomatous Hypertrophy of the Interatrial Septum". American Journal of Roentgenology. 182 (3): 598–600. doi:10.2214/ajr.182.3.1820598. ISSN 0361-803X.
  48. ↑ Saboo, Sachin S.; Krajewski, Katherine M.; Zukotynski, Katherine; Howard, Stephanie; Jagannathan, Jyothi P.; Hornick, Jason L.; Ramaiya, Nikhil (2012). "Imaging Features of Primary and Secondary Adult Rhabdomyosarcoma". American Journal of Roentgenology. 199 (6): W694–W703. doi:10.2214/AJR.11.8213. ISSN 0361-803X.
  49. ↑ Papillary fibroelastoma of the heart. Dr Craig Hacking et al http://radiopaedia.org/articles/papillary-fibroelastoma-of-the-heart Accessed on November 24, 2015
  50. ↑ Papillary fibroelastoma .Wikipedia https://en.wikipedia.org/wiki/Papillary_fibroelastoma Accessed on November 24, 2015
  51. ↑ Lipoma. Dr Craig Hacking et al . Radiopedia. http://radiopaedia.org/articles/cardiac-lipoma Accessed on November 24, 2015
  52. ↑ Rhabdomyoma. Wikipedia.https://en.wikipedia.org/wiki/Rhabdomyoma Accessed on November 24, 2015
  53. ↑ Intracardiac thrombi. Dr Craig Hacking et al. Radiopedia.http://radiopaedia.org/articles/intracardiac-thrombi Accessed on November 24, 2015
  54. ↑ Secondary cardiac neoplasm. Radiopedia.http://radiopaedia.org/articles/secondary-cardiac-neoplasms Accessed on November 24, 2015


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