Cardiac Masses and Pseudomasses: An Overview about Diagnostic Imaging and Clinical Background

Abstract

A cardiac lesion detected at ultrasonography might turn out to be a normal structure, a benign tumor or rarely a malignancy, and lesion characterization is very important to appropriately manage the lesion itself. The exact relationship of the mass with coronary arteries and the knowledge of possible concomitant coronary artery disease are necessary preoperative information. Moreover, the increasingly performed coronary CT angiography to evaluate non-invasively coronary artery disease leads to a rising number of incidental findings. Therefore, CT and MRI are frequently performed imaging modalities when echocardiography is deemed insufficient to evaluate a lesion. A brief comprehensive overview about diagnostic radiological imaging and the clinical background of cardiac masses and pseudomasses is reported.

Keywords: benign tumors; cardiac masses; malignant neoplasms; non-neoplastic lesions; pseudomasses.

Figure 1

Warfarin ridge at transesophageal echocardiography.

Figure 2

Axial cine MR sequences (a) and T1-weighted images (b) in a patient with prominent crista terminalis.

Figure 3

A prominent eustachian valve at transesophageal echocardiography.

Figure 4

Right ventricle pronounced muscolar ridge which extends from the basal ventricular septum to the free wall on cine images (a), late gadolinium enhancement MR sequence (b), and T2 mapping image (c).

Figure 5

81-year-old female patient with lipomatous hypertrophy of the interatrial septum in CT scan.

Figure 6

A 65-year-old male patient with lipomatous hypertrophy of the interatrial septum on coronal and axial CT images (a,b), volume rendering (c), which showed focal uptake of FDG in PET/CT scan (d).

Figure 7

Left atrium appendage thrombus at transesophageal echocardiography (a) and CT (b).

Figure 8

A 67-year-old female patient with left ventricle thrombus related to myocardial infarction on late gadolinium enhancement MR sequence.

Figure 9

A mitral valve vegetation at 2D (a) and 3D (b) transesophageal echocardiography, and at CT (c,d).

Figure 10

Prosthetic aortic valve infective endocarditis with vegetations at transesophageal echocardiography.

Figure 11

Electro-catheter endocarditis at transesophageal echocardiography (a) and CT (b).

Figure 12

A 74-year-old female patient with mitral annular calcification on precontrast-phase CT image (a) and cine sequence (b).

Figure 13

A 70-year-old female patient with a large right pericardiophrenic angle pericardial cyst on axial T2 STIR (a) and four-chamber view late gadolinium enhancement (b) MR imaging.

Figure 14

A 65-year-old male patient with a partially thrombosed giant aneurysm of the left main coronary artery on short-axis view (a), multiplanar reconstruction (b) and volume rendering (c,d) CT images.

Figure 15

A 67-year-old male patient with huge left ventricle aneurysm after myocardial infarction on four-chamber cine sequence (a) and axial late gadolinium enhancement MR sequence (b).

Figure 16

Right atrioventricular groove IgG4-related disease on arterial CT phase (a) and on cine MR sequence (b).

Figure 17

A 57-year-old male patient with sarcoidosis on axial cine sequence (a), short tau inversion recovery sequence (b), hilar and pulmonary involvement on balanced-steady-state free precession images (c), T2 mapping (d), native T1 mapping (e) and post-contrast T1 mapping (f) sequences (normal T2 value < 50 ms and normal native T1 value < 1045 in our site).

Figure 18

Echocardiography (a), T1-weighted (b) and T1-weighted gadolinium-enhanced MR sequences (c) in a patient with spontaneous acute left atrial hematoma.

Figure 19

A 26-year-old female patient with left ventricular myocardium echinococcus cyst, which is hyperintense with a dark rim on cine MR sequence.

Figure 20

Left atrial myxoma at 2D (a) and 3D (b) transesophageal echocardiography, perfusion (c) and late gadolinium enhancement (d) MR imaging.

Figure 21

Left atrial myxoma on three-chambers view (a) and three-dimensional volume rendering (b) CT images in a 45-year-old male patient.

Figure 22

Right atrial myxoma isointense on T1-weighted images (a), hyperintense on T2-weighted images (b), hyperintense and mildly heterogeneous on late gadolinium enhancement sequence (c).

Figure 23

A 28-year-old male patient with an aortic cusp fibroelastoma during transesophageal echocardiography (a), iso/hypointense on axial (b) and left ventricular outflow tract (c) cine sequences, and hyperintense on axial T2-weighted images (d).

Figure 24

A left ventricular outflow tract fibroelastoma of about one centimeter during transesophageal echocardiography (a), CT (b) and cine MR imaging (c). These images show that a fibroelastoma can be more easily evaluable during ultrasonography.

Figure 25

Right atrium (*) posterior wall capsulated ovoid fatty mass in CT scan (a), T1-weighted images (b,d) and cine (c) MR images.

Figure 26

A 52-year-old woman with an interventricular septum lipoma on cine sequences (a), native T1 mapping (b) and post-contrast T1 mapping (c) sequences.

Figure 27

A neonate with a basal anterior and mid-cavity anterior left ventricular wall mass on balanced steady-state free precession sequence (a) and short tau inversion recovery MR sequence (b).

Figure 28

A 56-year-old male patient with right atrial and right atrioventricular groove masses on four-chamber cine sequence (a), short tau inversion recovery (b), double-inversion recovery (c) and native T1 mapping (d) MR sequences (normal native T1 value < 1045 in our site).

Figure 29

A right atrioventricular groove paraganglioma with predominant peripheral enhancement due to central necrosis on arterial phase CT image.

Figure 30

CT images of a 66-year-old female patient with multiple pericardial metastases (white arrows—images (a,b)) and lymphadenopathies (white arrow—image (c)) who previously underwent left lobectomy for lung adenocarcinoma.

Figure 31

Uterine sarcoma visceral pericardial metastasis on two-chamber steady-state free precession (a), short tau inversion recovery (b), first-pass perfusion (c) and late gadolinium enhancement MR sequences (d).

Figure 32

Left ventricle metastasis on precontrast (a) and postcontrast (b) transthoracic echocardiogram images; primitive lung lesion (c) and cardiac metastasis on venous phase CT (d); cardiac secondary tumor on four-chamber cine (e) and short-axis T2 STIR (f) MR imaging.

Figure 33

A 72-year-old male patient with right ventricular outflow tract colorectal cancer metastasis in CT scan (a), MR imaging (b,c) and FDG PET/CT scan (d).

Figure 34

Right ventricular melanoma metastasis (*) with intermediate-high signal intensity on cine sequence (a), high native T1 mapping values (1600 ms) (b), and avid FDG uptake in PET-CT scan (c).

Figure 35

A 37-year-old male patient with a right atrial angiosarcoma at CT (a), on precontrast (b) and postcontrast (c) T1-weighted images.

Figure 36

Right ventricular outflow tract and pulmonary primary cardiac leiomyosarcoma at CT (a,b).

Figure 37

A 63-year-old male patient with right heart large B-cell lymphoma on four-chamber (a), axial (b) and short-axis CT (c) views.

Figure 38

Parietal pericardium thickening (white arrow) and enhancement on late gadoliunium enhancement sequence (a) and cine MR images (b), with associated pericardial effusion (*).