ECHO 2013 / Cardiac Tumors and Masses

MYXOMA

Cardiac Chamber

•LA (75%)

•RA (20%)

•RV& LV (5%)

Site of Attachment:

•atrial septum (fossa ovalis) (90%)

•atrial wall, atrial appendage

MYXOMA

MVA = 0.4 cm2

PASP=76 mm Hg

CARDIAC MYXOMA

MYXOMA: Heritability

•Familial myxoma occur in 7-10%

–autosomal dominant transmission

–Chromosomes 2, 17

•“Carney’s Complex”

–Cardiac and extra-cardiac myxomas (skin, breast)

–Cardiac myxomas in atypical locations;

–occasionally multiple - biatrial

–spotty pigmentation (lentigines, pigmented nevi or both)

–endocrine overactivity

–young age at occurrence with high recurrence (12-22%)

Familial Myxoma

•72 yo woman with prior resection of a myxoma on the mitral valve.

CARDIAC PAPILLARY

FIBROELASTOMA

•Primary valvular tumor

•Locations:

–Most often valvular - majority found on mitral and aortic valve; rarely on pulmonic or tricuspid

•Aortic valve – more commonly seen on the arterial side of the valve

•Mitral valve – more commonly seen on the left atrial side

–May occur on any endocardial surface, less common

•Generally found in patients over 60 years of age.

CPF: Echocardiographic Characteristics

•Round, oval or irregular

•well-demarcated and homogenous

•Speckled appearance with “shimmering” edge

•Often mobile and pedunculated; connected by a short stalk

•Sensitivity and specificity of TTE: 88.9% and 87.8% respectively

•Overall accuracy 88.4% for the detection of fibroelastoma ≥0.2 cm

Sun et al, Circulation 2001; 103:2687-2693

CPF: Echocardiographic Characteristics

fibroelatoma

•Differential Dx

–Vegetation

–Thrombus

–other benign tumors

vegetation