Fig. 18.1
(a) Single frontal view of the chest shows cardiomegaly . (b) Axial image from a contrast-enhanced CT scan of the chest shows a large, low-density mass filling the left ventricle with mass effect on the right ventricle in a patient with a subsequent tissue diagnosis of cardiac angiofibroma
Fig. 18.2
a, Single frontal view of the chest shows an irregular left upper heart border (black arrow) and some mediastinal shift to the right. b, Coronal image from a contrast-enhanced T1-weighted cardiac MRI shows an enhancing mass filling the right ventricle (black arrow); note that the thymic gland (blue arrow) is deviated to the right
The tumor may have central calcifications, which are seen on CT scans. On MRI, the tumor is T1-hypointense or isointense and T2-hypointense with enhancement on delayed imaging. On echocardiography, it appears as a noncontractile, heterogeneous mass.
Patients may experience arrhythmias, heart failure , or sudden cardiac death.
18.2 Imaging
The best diagnostic clue is central calcification and a relative lack of vascularity.
18.2.1 Radiographic Findings
Radiographs show nonspecific cardiomegaly, and calcifications may be seen.
18.2.3 CT Findings
CT may show central calcification within a discrete mass [3]. Non-specific low attenuation mass is seen in the majority of cases.
18.2.4 MRI Findings
Masses are hypointense to isointense to myocardium on T1-weighted images, and are T2 hypointense. Images may show heterogeneous enhancement with lower central intensity secondary to low vascularity in this region.
The lesion may be hyperenhancing on delayed imaging. On MR angiography (MRA), a hypointense mass is seen [4].
18.2.5 Echocardiography Findings
Echocardiography will show a large, solid, heterogeneous mass that is noncontractile [3].
18.2.6 Imaging Recommendations
Echocardiography is the modality most commonly used for detection of these masses. A hypoenhancing central focus on T2 MR imaging with delayed enhancement suggests fibroma, and if central calcification is seen on CT, the mass is very likely to be fibroma.
