Cardiac tumour

Images Roger Burrell

A 60 year old man presented to the Emergency Department short of breath having a  known right ventricular cardiac tumour with metastases to the lung, liver, spleen and bone. On examination saturating 100% on RA, bilateral pitting pedal oedema, BP, 120/60, HR 68/min.

An ECHO was performed in the Emergency department.

The PLAX shows a large mass in the right ventricle

This is the  PSAX  showing the large tumour  and flattening of the IVS causing a D shaped ventricle

From the PSAX through the aortic valve  the large RV tumour is visible causing RVOT obstruction

The 4CV shows the large RV mass, IVS flattening and tumour involvement of the lateral tricuspid valve annulus

The subcostal view  shows the tumour indistinctly as there is poor penetration of sound waves in this view

Discussion

  • Cardiac tumours are rare
  • Metastatic cardiac tumours are 20 – 30 times more common than primary cardiac tumours
  • Metastatic tumours are all malignant
  • Primary cardiac tumours are more commonly benign than malignant
  • Prognosis is in general uniformly poor.

Metastatic cardiac tumours:

  • Clinical presentation is dependent on tumour location
  • Over 60% involve the pericardium causing effusions or pericarditis

Primary cardiac tumours : benign tumours

  • These tumours include papillary fibroelastomas, myxomas , lipomas and cardiac hemangiomas
  • Very rare – incidence 0.02%
  • Problems arise because of their location as they may interfere with blood flow, valve function, cause arrythmias or embolise either to the lungs (if right sided) or to the brain if left sided.
  • Patients are usually asymptomatic until complications arise
  • Some tumours (myxomas) are associated with constitutional symptoms such as fever, rash or anorexia
  • Tumours can have a solid or papillary appearance. Papillary tumours are more friable and embolise more frequently

Primary cardiac tumours : malignant

  • These tumours include undifferentiated pleomorphic sarcomas, angiosarcomas , mesotheliomas and primary cardiac lymphomas
  • Patients with angiosarcomas may present with chest pain, SOB, weight loss and malaise. Because of their vascular nature they may also cause cardiac tamponade from catastrophic bleeding

Treatment options for cardiac tumours include resection of the tumour, angio embolisation, chemotherapy and radiotherapy depending on their subtype and their location

References

  1. Neoplasia and the Heart Pathological Review of Effects With Clinical and Radiological Correlation
    Joseph J. Maleszewski, Melanie C. Bois, John P. Bois, Philip M. Young, John M. Stulak and Kyle W. Klarich  Journal of the American College of Cardiology
    Volume 72, Issue 2, July 2018  DOI: 10.1016/j.jacc.2018.05.026

 

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