Approach to cardiac masses: Thinking inside and outside the box

Abstract

In this editorial we comment on the article by Huffaker et al, published in the current issue of the World Journal of Clinical Cases. Cardiac masses encompass a broad range of lesions, potentially involving any cardiac structure, and they can be either neoplastic or non-neoplastic. Primitive cardiac tumors are rare, while metastases and pseudotumors are relatively common. Cardiac masses frequently pose significant diagnostic and therapeutic challenges. Multimodality imaging is fundamental for differential diagnosis, treatment, and surgical planning. In particular cardiac magnetic resonance (CMR) is currently the gold standard for noninvasive tissue characterization. CMR allows evaluation of the relationship between the tumor and adjacent structures, detection of the degree of infiltration or expansion of the mass, and prediction of the possible malignancy of a mass with a high accuracy. Different flow charts of diagnostic work-up have been proposed, based on clinical, laboratory and imaging findings, with the aim of helping physicians approach the problem in a pragmatic way ("thinking inside the box"). However, the clinical complexity of cancer patients, in particular those with rare syndromes, requires a multidisciplinary approach and an open mind to go beyond flow charts and diagnostic algorithms, in other words the ability to "think outside the box".

Keywords: Cardiac magnetic resonance; Cardiac masses; Cardiac tumors; Cardio-oncology; Primitive cardiac tumors.

Figure 1

Localization, pathophysiology, and histopathological aspects of cardiac masses. Citation: Castrichini M, Albani S, Pinamonti B, Sinagra G. Atrial thrombi or cardiac tumours? The image-challenge of intracardiac masses: a case report. Eur Heart J Case Rep 2020; 4: 1-6. Copyright© The Authors 2020. Published by Oxford University Press on behalf of the European Society of Cardiology. The authors have obtained the permission for figure using from the European Heart Journal - Case Reports (Supplementary material).

Figure 2

Flow chart of the diagnostic workup in patients with cardiac masses. CT: Computed tomography; MRI: Magnetic resonance imaging; PET: Positron emission tomography; TEE: Trans esophageal echocardiography; TTE: Trans thoracic echocardiography.