Download Data Supplement Table - Circulation: Cardiovascular Imaging

Differential diagnosis of space occupying lesions in the heart *
Type of lesions
Prevalence §
Most Common Location
Pathologic Features
Echo. Features
CT Features
MR Imaging Features
Myxoma
30 %
LA(83%), RA(13%),
Pedunclated solitary
Mobile tumor, narrow
Heterogeneous,
Heterogeneous, bright on
subendocardial
tumor (>90%) with a
stalk
low attenuation
T2WI; heterogeneous
stalk to subendothelium
Lipomas
10 %
enhancement
Subendocardial and
Very large, broad-based;
Hypoechoic in the
Homogeneous
Homogeneous fat signal
subepicaridal tumor, no
no calcification,
pericardial space,
fat attenuation
intensity (increased T1);
chamber predilection
hemorrhage, or necrosis
echogenic in a cardiac
(low attenuation)
no enhancement
chamber
Papillary
8%
fibroelastomas
Rhabdomyomas **
Fibromas
6%
3%
80-90% on valvular
1cm lesion with delicate
Small, mobile masses
a mass on a valve leaflet or on the endocardial
endocardium, aortic
papillary fronds, single in
attached to the valve
surface on CT or MR imaging.
valve most common
91%
with a short pedicle
Ventricles > atria
multiple small (<1mm)
Multiple, small,
Multiple nodules,
T1-isointense and
lesions. in most tuberous
homogeneous,
hyper or hypo-
T2-hyperintense relative
sclerosis (50%)
hyperechoic intramural
attenuating
to myocardium. Contrast
associated.
tumors.
.
enhancement.
Interventricular septum
Solitary intramural tumor
Intramural, calcified
Low attenuation,
Isointensity on T1WI,
and left ventricular free
(5-cm average size)
calcified
dark on T2WI; No
wall in > 90%
Hemangioma
Metastatic tumors
Angiosarcomas
2%
@
8%
Ventricles > atria
Pericardium
90% in right atrium
enhancement.
Multiple tumors in 30%
Hyperechoic lesions
Heterogeneous at
isointensity on T1WI and
unenhanced CT,
hyperintensity on T2WI.
Contrast
Inhomogeneous
enhancement.
enhancement at contrast
***
large, heterogeneous,
Nearly always multiple
Pericardial effusion is
microscopic nests and
the most common echo
broad based masses with
discrete nodules.
finding.
tumor necrosis.
Intramural mass with
Echocardiography is
protrusion into the cavity,
excellent for initial
intermediate intensity on
infiltrative, frequent
visualization of
T1WI, clear demarcation
involvement of
malignant cardiac
on T2WI. Contrast
pericardium.
#
lesions
***
Mosaic pattern:
enhancement.
Rhabdomyosarcomas
5%
No chamber predilection
Multiple lesions seen in
#
***
Homogeneous,
60%, infiltrative
Isointense on T1WI, and
hyperintense on T2WI.
Contrast enhancement.
Leiomyosarcomas
Primary cardiac
1%
2%
lymphomas
Cardiac thrombi
Vegetations
70-80% in LA, may
Solitary lesion in70%,
#
***
Isointense on T1WI, and
involve pulmonary trunk
infiltrative
Right side of the heart in
Single lesion in 66% and
Echo, CT and MR signals are not specific, and histopathologic diagnosis
69-72%
multiple lesions in34%,
is required. Most commonly manifest as circumscribed, nodular masses
may pericardial effusion
in the myocardium, often with an associated pericardial effusion.
hyperintense on T2WI.
Cardiac
Most in LV apex or
Most in atrial fibrillation,
More echogenic than
Most thrombi are
Increased intensity on
thrombi are
LA appendage
enlarged atrial chamber,
the underlying myo-
not mobile.
T1WI and lower
more
low cardiac output state,
cardium, and a contour
differentiating a
intensity on T2WI. No
frequent
and wall motion
distinct from the
thrombus from other
contrast enhancement.
than tumors
abnormalities
endocardial border.
tissues density
Incidence of
Typically attached to
Growing in size, either as
homogeneous, mobile,
CT and MRI may have a role in the diagnosis
IE: 3.6~7
valve, upstream side.
a sessile clump or a
echogenic, irregular
of endocarditis complications, especially aortic
cases per
highly mobile and even
mass.
root abscesses and aneurysms ##
100,000
pedunculated mass.
patient-year
Irregular shape.
*: 1. Moluk Mirrasouli Ragland, and Tahir Tak. The role of echocardiography in diagnosing space-occupying lesions of the heart. Clinical Medicine & Research. 2006:
volume 4, number 1: 22-32.
2. Bruce McManus and Cheng-Han Lee. Braunwald’s Heart Disease: a textbook of cardiovascular medicine. 8 th ed. Philadelphia, PA: Saunders Elseviers; 2008,
1815-1828.
§: Relative frequency of primary cardiac tumors: from Feigenbaum et al. Feigenbaum’s echocardiography. 6 th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2005.703.
**: the most common benign pediatric tumors;
@: 20 times more common than primary cardiac tumors.
*** : Features suggesting malignancy : 1. Wide attachment to walls of heart; 2. Destruction of cardiac chamber walls 3. Invasion of pericardium and particularly hemorrhage
4. Extension into the pulmonary arteries or veins, or vena cava
metastatic spread
5. Involvement of two cardiac chambers
6. Necrosis of the mass lesion
7. Multiple lesions suggest
8. Involvement beyond the pericardium, lung or mediastinum.
#: Echocardiographic examination focuses on the anatomic location and extent of the tumor involvement, the physiologic consequences of the tumor (e.g., valve regurgitation,
chamber obliteration, obstruction) and associated findings (pericardial effusion, evidence of tamponade physiology)
##: CT or MR in the diagnosis of infective endocarditis has not yet been established.