Multimodality Imaging of Benign Primary Cardiac Tumor

Abstract

Primary cardiac tumors (PCTs) are rare, with benign PCTs being relatively common in approximately 75% of all PCTs. Benign PCTs are usually asymptomatic, and they are found incidentally by imaging. Even if patients present with symptoms, they are usually nonspecific. Before the application of imaging modalities to the heart, our understanding of these tumors is limited to case reports and autopsy studies. The advent and improvement of various imaging technologies have enabled the non-invasive evaluation of benign PCTs. Although echocardiography is the most commonly used imaging examination, it is not the best method to describe the histological characteristics of tumors. At present, cardiac magnetic resonance (CMR) and cardiac computed tomography (CCT) are often used to assess benign PCTs providing detailed information on anatomical and tissue features. In fact, each imaging modality has its own advantages and disadvantages, multimodality imaging uses two or more imaging types to provide valuable complementary information. With the widespread use of multimodality imaging, these techniques play an indispensable role in the management of patients with benign PCTs by providing useful diagnostic and prognostic information to guide treatment. This article reviews the multimodality imaging characterizations of common benign PCTs.

Keywords: benign primary cardiac tumor; multimodality imaging.

Figure 1

Left atrial myxoma in a 69-year-old man presenting with chest tightness and shortness of breath. (A) Transthoracic echocardiography showing a pedunculated mobile heterogeneous echogenic mass attached to the interatrial septum. This mass locates in the LA. (B) Part of this mass protruding into the LV through the mitral valve orifice in diastole, leading to stenosis of the mitral valve orifice. (C) Contrast-enhanced CT demonstrating a relative low density well-circumscribed mass originating from the interatrial septum, with absent of enhancement. (D) PET-CT imaging revealing the radionuclides slightly concentrated in the mass (SUVmax 4.6). (E) Pathology confirming myxoma. White arrows pointing to the left atrial myxoma and † marking stalk.

Figure 2

Incidental finding of a papillary fibroelastoma in a 62-year-old man. (A) A small mobile solid mass attaching to the aortic valve on transthoracic echocardiography. (B) Transesophageal echocardiography clearly showing the mass of aortic valve. (C) Three-dimensional echocardiography clearly visualizing the location and size of the mass. (D) CMR demonstrating a round, small, homogeneous mass attached to aortic valvular leaflet. (E) Pathology confirming papillary fibroelastoma. White arrows representing the papillary fibroelastoma.

Figure 3

Rhabdomyoma incidentally found in a nine-month-old child. (A,B) Transthoracic echocardiography demonstrating multiple slightly hyperechoic masses in the LV and RV. (C,D) CMR confirming multiple biventricular masses. White arrows denoting the rhabdomyoma.

Figure 4

Cardiac fibroma in a 3-year-old child manifesting as palpitation and cough. (A) Transthoracic echocardiography demonstrating a large heterogeneous intramyocardial mass with sporadic calcific. (B) Contrast echocardiography revealing slight enhancement of contrast agent within the mass. (C) CMR showing an intramyocardial mass presenting iso-intense on T1-weighted images. (D) On T2-weighted images, the mass appearing slight hyper-intense. (E) The mass presenting as hypoperfusion on resting first-pass perfusion images. (F) LGE imaging revealing the mass appeared as obviously inhomogeneous high signal intensity relative to the myocardium. (G) Pathology confirming fibroma. White arrows pointing to the cardiac fibroma.

Figure 5

Cardiac cavernous hemangioma in a 16-year-old man presenting with palpitation. (A) Transthoracic echocardiography showing a heterogenous echogenic mass in the lateral wall of the LV. (B) Color Doppler flow imaging revealing coronary artery blood flow within the mass. (C) Contrast echocardiography demonstrating enhancement of contrast agent within the mass. (D) The left ventricular wall appearing inhomogeneous thickening with local nodules and diffuse edema on T2-weighted images. (E) Late gadolinium enhancement imaging demonstrating that the lateral wall of the left ventricle presented as obviously inhomogeneous hyperintense. (F) On contrast-enhanced CT, the coronary artery branches increased in the left ventricular myocardium. (G) Coronary angiography confirms the coronary arteries give off many branches and myocardial obviously staining in arterial phase. (H) Pathology confirming cavernous hemangioma. White arrows representing the cardiac cavernous hemangioma.