ECHO 2013 / Cardiac Tumors and Masses
.pdfMYXOMA
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.
CARDIAC PAPILLARY FIBROELASTOMA
Alternate Names
• |
Valve papilloma |
• Papillary clastofibroma |
• |
Papilliferous tumor |
• Fibroangiomyxoma |
• |
Papillary fibroma |
• Fibroelastic hamartoma |
• Papillary myxoma |
• Hemangiofibroma |
|
• Myxofibroma |
• Hemangioelastomyxoma |
|
• Endocardial tumor |
• Giant Lambl's excrescence |
• Endocardial papillary excrescence
CPF: Pathology
•Resemble a sea anemone with multiple papillary fronds attached to the endocardium by a short pedicle.
•Size range: 2 to 28 mm; 99% < 20 mm
•Single isolated tumor; rarely can be multiple
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