Cardiac Masses in Echocardiography: A Pragmatic Review

Abstract

Transthoracic echocardiography is a useful diagnostic technique for the identification of intracardiac and extracardiac masses, which can evaluate morphologic properties of the masses such as their location, attachment, shape, size, mobility, and possible hemodynamic-related implications. Apart from physiological variants and structural normal mimickers, echocardiography can detect principal intracardiac masses such as neoplasms, thrombi, vegetation, and extracardiac masses such as metastatic lesions. Moreover, transesophageal echocardiography can provide further details and provide higher accuracy in case a deeper examination of the mass is needed. This review will focus on the systematic evaluation of intra-/extracardiac masses including epidemiology and morphological and echocardiographic features, providing practical and technical tips to health-care professionals to achieve correct identification of the masses. General data on cardiac masses were extracted via PubMed/MEDLINE search engine from indexed reviews, original studies, and clinical case reports. The echocardiographic features of cardiac masses were reviewed according to the most relevant international cardiology and echocardiography scientific societies' position statements.

Keywords: Cardiac masses; echocardiography; neoplasia; thrombus; vegetation.

Figure 1

Transthoracic echocardiography apical four-chamber view; white arrow: Crista terminalis. RA = Right atrium

Figure 2

Transoesophageal echocardiography 19° short-axis view, pointing left atrial appendage; white arrow: Interauricular thrombus; *Spontaneous echo contrast into the LA. LA = Left atrium

Figure 3

Transthoracic echocardiography apical four-chamber view of a dysfunctional mechanical, mitral prosthetic valve with intravalvular thrombus; white arrows: Hyperechoic effect beyond the level of the prosthetic thrombotic valve; white head arrow: Aliasing effect on color Doppler box due to blood flow turbulence related to prosthetic dysfunction because of intravalvular mass

Figure 4

Transthoracic echocardiography apical four-chamber view with the presence of an apical thrombus; white arrow: Apical, intraventricular isoechoic thrombotic mass with defined margins distinct from the endocardial edge

Figure 5

Transthoracic echocardiography three-dimensional apical four-chamber view showing an apical pedunculated thrombus; white arrow: Apical left ventricular, intraluminal thrombus

Figure 6

Transthoracic echocardiography apical 4-chamber view showing a right intra-atrial thrombus; white arrow: bilobated intra-atrial thrombus; *Small, anechoic amount of pericardial effusion

Figure 7

Transesophageal echocardiography 124° view at the level of aortic valve showing aortic vegetation; white arrow: Vegetation; LVOT = Left ventricular outflow tract; Ao = Ascending aorta

Figure 8

Transesophageal echocardiography 41° view showing the right sections of the heart and a vegetation attached to an implantable cardioverter lead; white arrow: Vegetation; white head arrow: Implantable cardioverter lead. RA = Right atrium; LA = Left atrium; RV = Right ventricle

Figure 9

Transthoracic echocardiography apical five-chamber view showing a myxoma into the left atrium; white arrow: Myxoma; RA = Right atrium; LA = Left atrium

Figure 10

Transthoracic echocardiography subcostal view showing a myxoma into the left atrium attached to the basal part of the interatrial septum; white arrow: Myxoma; white head arrow: Interatrial septum; RA = Right atrium; LA = Left atrium

Figure 11

Three-dimensional transesophageal echocardiography reconstruction and multiplanar views of fibroelastoma attached to the left coronary aortic cusp; white and black arrows: Fibroelastoma mass

Figure 12

Three-dimensional transesophageal echocardiography image of fibroelastoma attached on the left coronary aortic cusp; white arrow: fibroelastoma mass

Figure 13

Transthoracic echocardiography apical four-chamber view showing a pericardial metastatic lesion of a primary melanoma; black arrow: Metastatic pericardial mass

Figure 14

Transthoracic echocardiography apical four-chamber view showing an extracardiac, isoechoic mass represented by pulmonary neoplasia; *Extracardiac neoplasia

Figure 15

Transthoracic echocardiography subcostal off-axis view showing a neoplastic renal mass protruding into the lumen on inferior vena cava; white arrow: Renal echo-dense mass neoplasia

Figure 16

Transthoracic echocardiography parasternal long-axis view showing a large isoechoic/hyperechoic hiatal hernia close to the posterior wall of the left atrium; black arrows: Hiatal hernia