Differential diagnosis of cardiac tumors: General consideration and echocardiographic approach

Figures

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  FIGURE 1. Tumor thrombus extending from the inferior vena cava to the right atrium in a patient with liver carcinoma. A. TTE‐2D Apical four‐chamber modified. B. The color Doppler helps to better define the irregular shape, typical of tumor thrombi. C. Right atrial mass without any relationship with the inferior vena cava, in a patient with metastatic sarcoma. TTE‐2D Apical four chamber. The mass has the same echogenicity of the intrapleural metastasis (red arrow). This mass should be considered a metastasis

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  FIGURE 2. A. Papillary fibroelastoma of the aortic valve. TTE‐2D Long x is in diastole. Thin stalk at the aortic surface of the cusps (red arrow). B. Right atrium Angiosarcoma. TTE‐2D apical four chamber. Broad insertion on the lateral right atrial wall, with infiltration of the tricuspid annulus (yellow arrow). The mass has a lobulated surface

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  FIGURE 3. Two cases of angiosarcoma. A: Apical four chamber view of a huge mass infiltrating the right atrium, right ventricle and the pericardium. B: TOE‐2D is focused on the right chambers. The mass infiltrates the interatrial septum, the roof and the lateral wall of the right atrium

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  FIGURE 4. Two cases of lymphoma (TTE‐2D Apical four‐chamber). A. The mass infiltrates the interatrial septum, the roof of the right atrium and the superior vena cava. B: A large massoccupying most of the right atrIum infiltrating the lateral wall, the atrio‐ventricular groove and the right ventricle BIS. Pericardial lymphoma. A. TTE‐2D Apical four‐chamber. B. TTE‐2D subcostal four‐chamber The huge mass infiltrates the free wall of the right ventricle and is not homogeneous (haemorrhagic foci). The mass takes up pericardial effusion. Cardiac MRI, CT scan and PET were performed. Biopsy allowed the phenotypic characterization and the tailored chemiotherapy TER. The same patient of BIS. A‐B‐C TTE‐2D subcostal four‐chamber. Echocardiography was performed within 2 months of each other to assess the efficacy of chemiotherapy. In C the lymphoma is no longer recognizable

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  FIGURE 5. Patient with mitral bioprosthetic valve and diagnosis of left atrium sarcoma. A low‐echogenic mass occupies almost entirely the left atrium. The color Doppler allows the identification of the contour line of the mass. TTE‐2D 4 chamber (top) and short axis (bottom) pre (left) and after (right) chemotherapy. After chemotherapy, the mass is markedly reduced in size and the color fills most of the left atrial cavity and the pulmonary veins

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  FIGURE. 6. TTE‐2D. Four‐chamber apical view in six patients with left atrial myxomas of different sizes

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  FIGURE 7. TOE‐3D. Multiplanar reconstruction of the mass (A) and linear measurements along orthogonal planes (B)

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  FIGURE 8. Left atrial myxoma attached to the fossa ovalis (usual site). TOP: TTE‐2D Apical four chamber. Systole (A), Diastole (B). The red arrow indicates left atrial mass. The yellow arrows indicate the site of attachment. Bottom: transmittal Doppler study assessing the obstruction (C), And the surgical specimen

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  FIGURE 9. Right atrium angiosarcoma. TOE‐2D mid‐upper position. The two views are focused on right chambers in systole. An irregular and dishomogeneous giant mass (60 × 45 mm) infiltrates the free wall and the tricuspid annulus and protrudes into the right atrium

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  FIGURE 10. A left atrial myxoma attached on atrial septum below the fossa ovalis (unusual site). Tee‐2d apical four chamber. Systole (A), Diastole (B). The red arrow indicates left atrial mass. The yellow arrows indicate the stalk

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  FIGURE. 11. Top: TEE long axis view of an aortic papillary fibroelastoma. The mass is measured on zoomed still frames (1.32 mm). Red arrow indicates the head of the mass. The yellow arrow indicates the stalk. The attachment is on the ventricular side of aortic cusp at level of the mid portion. (An unusual site of attachment, Bottom: surgical specimen

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  FIGURE 12. A. Sarcoma infiltrating the pericardium and the lateral wall of the left ventricle (Red arrow). B. Global Longitudinal strain shows low values of strain (−11% and – 8%) at level of infiltrated walls (Yellow arrow)