Other masses with the differential diagnosis of cardiac tumors





Key points




  • •

    Extracardiac cardiac masses are important to the cardiologist because they can sometimes compress the heart or the great vessels, which enter or emerge from the heart, and, thus, simulate tamponade, constrictive pericarditis, or congestive heart failure.


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    They are important also to the echocardiographer because their presence may be unexpectedly revealed on routine echocardiography, or because by encroachment on the cardiac chambers such as the atria, they distort normal anatomic contours or mimic intraatrial neoplasms or thrombi.



Table 27.1

Mechanisms of the involvement of echocardiographic views by mediastinal masses .












Proximity The abnormal mass is contiguous or adjacent to the heart and recognizable in 1 or more of the 2D echocardiographic views, but it does not deform or indent the cardiac chambers
Encroachment The mediastinal mass encroaches on 1 or more heart chambers, narrowing or otherwise distorting them, but it does not cause adverse hemodynamic effects (However, the patient may be symptomatic from the pressure effects of the mass on the esophagus, the trachea, or the other noncardiac structures.)
Compression The mediastinal mass is large and rigid or, if cystic, under high pressure, and can compress the heart. Thereby, it produces hemodynamic effects and symptoms like tamponade. This mechanism is mostly due to a large, firm, solid mass; a high-tension fluid accumulation; or an aortic aneurysm to seriously impair cardiac filling, in effect like tamponade

Fig. 27.2


The images illustrate an esophageal tumor. Transthoracic echocardiography shows the external compression of a large mass posterior to the left atrium with external compressive effects. The mass, however, does not exert obstructive effects on the left ventricular inflow. The mass is an esophageal tumor (Supplementary Video 27.1). The important point is that performing transesophageal echocardiography could be fatal in such a patient, and the external compression of esophageal masses should be in mind in all patients with left atrial masses before deciding to perform a transesophageal echocardiographic examination.




Supplementary Videos 27.1 and 27.2


The detection of an echodensity over the left atrium by echocardiography underscores the significance of skillful manipulations such as (1) the use of harmonic images that can improve the quality of the far gain image; (2) the employment of color flow images since there will be some blood flow around the mass if the mass, either primary or secondary in origin, is really inside the chamber; and (3) the adjustment of the probe angulation to see the tumor margin. If the convex margin of the tumor mass is found, extracardiac tumors should be considered. The probe angulation can see the correlation between the tumor motion and the chamber motion; nonetheless, moving the probe too fast can mimic the tumor moving with the heartbeats. Additionally, if the mass lesion is found by echocardiography with a target characteristic, a tumor in the lower third of the esophagus with circumferential wall thickness compressing the left atrium could be another differential diagnosis .


Fig. 27.3


The images demonstrate a lung tumor. Transthoracic echocardiography in the apical 4-chamber view shows an extracardiac, isoechoic mass compressing the left atrium. The mass is a pulmonary neoplasm.

From L’Angiocola PD, Donati R. Cardiac masses in echocardiography: a pragmatic review. J Cardiovasc Echogr 2020;30(1):5–14. https://doi.org/10.4103/jcecho.jcecho_2_20 .

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Oct 27, 2024 | Posted by in CARDIOLOGY | Comments Off on Other masses with the differential diagnosis of cardiac tumors

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