CT and MR imaging findings of malignant cardiac tumors
Section snippets
Metastases
Due to their proximity to the heart, most metastases originate in the lung or breast and less often from melanoma, lymphoma, and leukemia.1, 2, 3, 4 They typically occur as late manifestations of the primary tumor at a time when diffuse involvement of other organs already has occurred.5 Accordingly, patients may present with myriad signs and symptoms, such as chest pain, dyspnea, and arrhythmias, stemming from causes like pericardial extension, venous invasion, and myocardial infiltration.6, 7,
Sarcomas
Of the malignant primary cardiac tumors, sarcomas outnumber all others and typically affect middle-aged adults.18 Such soft-tissue malignant tumors usually arise in the left atrium, affect cardiac valves, and manifest various forms from endocardial/myocardial myxomatous masses to widespread infiltrative lesions.19 Heterogeneous enhancement often coupled with diffuse dissemination distinguishes their appearance on MRI (Fig 13).20
Angiosarcomas
The most prevalent of the cardiac sarcomas, angiosarcomas predominantly affect the right atrium of men aged 20 to 50 years old.21, 22 These highly vascular tumors exhibit hemorrhagic, necrotic foci with anastomosing vessels delineated by sheets of endothelial cells. As a result, when angiosarcomas invade the pericardium, hemorrhagic effusion often ensues, sometimes leading to cardiac tamponade.21 Other consequences include tumor emboli that obstruct pulmonary vessels, precipitating progressive,
Rhabdomyosarcomas
In terms of frequency, rhabdomyosarcomas rank first in children, surpassing even nonsarcomas as the most common malignant tumors in this age group.29 Like angiosarcomas, these striated-muscle tumors disproportionately affect males and involve the myocardium but only rarely infiltrate the pericardium diffusely or extend beyond it.30, 31 They may involve any chamber or cardiac valve with a frequency unsurpassed by other sarcomas.32 As with other cardiac neoplasms, clinical presentation is varied
Fibrosarcomas
Comprising 5% of all primary cardiac tumors, fibrosarcomas consist primarily of malignant fibroblasts that equally affect both sides of the heart.37, 38 Classified as nodular or infiltrative, these rare malignant mesenchymal tumors may obliterate entire chambers and extend into or even arise primarily from the pericardium.17, 37 As with leiomyosarcomas and osteosarcomas, left-sided involvement more commonly occurs.18 Consequently, signs and symptoms of congestive heart failure predominate.39
Lymphomas
Similar to other immune-cell-based tumors, cardiac lymphomas often affect immunocompromised patients, especially middle-aged men.42, 43 Such tumors, which consist predominantly of B cells, primarily originate in the heart and pericardium.31, 44 In most cases, multiple masses invade multiple chambers, particularly those on the right side, in addition to the pericardium, which often harbors concomitant effusion.45 Furthermore, they rarely exhibit necrosis or valvular involvement, unlike their
Hemangiopericytoma
An abnormal proliferation of perivascular endothelial cells, the pericytes of Zimmerman, distinguishes hem-angiopericytomas, which are extremely rare vascular sarcomas that even more rarely involves the heart.47 They preferentially affect women without chamber predilection.48, 49 T1WI and T2WI typically demonstrate heterogeneous, high signal (Fig 18).48
Conclusion
Unlike their benign counterparts, malignant cardiac and pericardial tumors predominantly originate more from without than from within. They both rely, however, on echocardiography to provide preliminary diagnostic information and CT and MRI for the most complete characterization, which is provided in part by their superior tissue resolution and tumor demarcation.
References (49)
Imaging of pericardial disease
Magn Reson Imaging Clin N Am
(2003)Primary and secondary neoplasms of the heart
Am J Cardiol
(1997)- et al.
Cardiac effects of noncardiac neoplasms
Cardiol Clin
(1984) - et al.
Primary cardiac sarcomas
Ann Thorac Surg
(1991) - et al.
Primary cardiac neoplasms. Early and late results of surgical treatment in 42 patients
J Thorac Cardiovasc Surg
(1987) - et al.
Unusual forms of pulmonary embolism
Clin Chest Med
(1994) - et al.
Sunray appearance on enhanced magnetic resonance image of cardiac angiosarcoma with pericardial obliteration
Am Heart J
(1994) - et al.
Primary cardiac valve tumors
Ann Thorac Surg
(1991) - et al.
Primary left ventricular rhabdomyosarcoma in a childnoninvasive assessment and successful resection of a rare tumor
J Thorac Cardiovasc Surg
(1987) - et al.
Surgical treatment of cardiac tumorsa 25-year experience
Ann Thorac Surg
(1990)
MR evaluation of cardiac and pericardial malignancy
Magn Reson Imaging Clin N Am
A combined modality approach to recurrent cardiac sarcoma resulting in a prolonged remissiona case report
Chest
Malignant lymphoma of the heart in acquired immune deficiency syndrome
Chest
Hemangiopericytomaan analysis of 106 cases
Hum Pathol
Neoplasms metastatic to the heartreview of 3314 consecutive autopsies
Am J Cardiovasc Pathol
Cardiac metastases
Cancer
Tumors of the heart. A 20-year experience with a review of 12,485 consecutive autopsies
Arch Pathol Lab Med
The natural history of lung cancer with pericardial metastases
Cancer
Anatomy, histology, and pathology of the cardiac conduction system—Part IV
Clin Cardiol
Malignant tumors of the heart and great vesselsMR imaging appearance
Radiographics
Transesophageal echocardiographic (TEE) evaluation of intracardiac and pericardial masses
Cardiol Clin
Obliteration of the pulmonary vein in lung cancersignificance in assessing local extent with CT
J Comput Assist Tomogr
Hepatocellular carcinoma with tumor thrombus in the inferior vena cava and right atrium
Abdom Imaging
Inferior vena cava tumor thrombus in renal cell carcinomastaging by MR imaging and impact on surgical treatment
Am J Roentgenol
Cited by (48)
Non-Hodgkin cardiac lymphomas
2021, Annales de Cardiologie et d'AngeiologieCardiac Lymphoma
2016, Radiologic Clinics of North AmericaCitation Excerpt :Prior studies suggest that because malignant cells have a higher concentration of free intracellular water content and a greater degree of surrounding interstitial edema, it should follow that malignant lesions would also have longer T1 and T2 relaxation times when compared with benign abnormality (Fig. 5).20,34,35 Although cardiac lymphomas may have a variable appearance on MR, they are commonly hypointense on T1W MR sequences and hyperintense on T2-weighted (T2W) sequences.36,37 The variable signal intensity may be determined by the cellularity of the tumor.
Cardiac Tumors
2016, Practice of Clinical EchocardiographyCardiac tumours
2015, Advanced Cardiac ImagingCardiac CT: Understanding and Adopting a New Diagnostic Modality
2009, Cardiology ClinicsCitation Excerpt :A detailed review of the applications of CT in electrophysiology is available in the article by Abbara in this issue. Cardiac CT is a useful imaging modality for evaluating cardiac masses, particularly to determine their location, extent, and anatomic relationships.27 Cardiac CT (CCT) provides superior resolution for detecting calcification and evaluating perfusion and relationship to noncardiac structures.
Cardiac Tumors
2008, Seminars in RoentgenologyCitation Excerpt :It occurs more commonly in middle-aged men, in the right atrium as a focal mass or diffuse thickening.4 This is a highly vascular tumor, with areas of hemorrhage, necrosis, and anastamotic vessels lined by atypical endothelial cells.4,5 As the tumor grows in the right atrium, it produces progressive obstruction, and eventual signs of right heart failure.