Incidental versus symptomatic benign cardiac tumours: real-world diagnostic delay and clinical presentation over 10 years

Background Benign primary cardiac tumours are increasingly detected incidentally during routine imaging. Whether incidental detection accelerates care pathways or, conversely, prolongs time to definitive management remains uncertain in real-world cardiology practice. Purpose To compare clinical profile, imaging workflow and timelines from first detection to final diagnosis and treatment between incidentally detected and symptomatic/non-incidental benign primary cardiac tumours. Methods We analysed a retrospective single-centre registry of consecutive adults with confirmed benign primary cardiac tumours managed over the last 10 years (N=28). All patients underwent surgical resection. Incidental detection was defined as detection mode "incidental" (n=6), whereas symptomatic/non-incidental pathways included emergency/inpatient/outpatient presentations leading to diagnosis (n=21); detection mode was missing/invalid in one case. We compared age, echocardiographic maximal tumour diameter, use of additional imaging (TEE/CMR/CT), diagnostic delay (first imaging identifying a mass to final diagnosis) and time from first imaging to treatment. Embolic events prior to treatment were recorded. Continuous variables are presented as median (IQR) and compared using non-parametric tests; categorical variables were compared using Fisher’s test. Results Incidentally detected patients tended to be older than symptomatic/non-incidental patients (69.0 [64.3–76.8] vs 60.0 [43.0–65.0] years; p=0.058), with comparable tumour size (24.0 [13.5–30.8] vs 25.0 [15.5–43.0] mm; p=0.83). Incidental detection was associated with longer diagnostic delay (81.5 [49.0–168.8] vs 17.5 [13.0–47.3] days; p=0.049) and longer time from first imaging to treatment (69.5 [32.3–160.0] vs 11.0 [5.5–32.5] days; p=0.039). Additional imaging was used more frequently in incidental cases (TEE 66.7% vs 47.6%; CMR 16.7% vs 4.8%; CT 33.3% vs 4.8%). Embolic events occurred in 0/6 incidental vs 7/21 symptomatic/non-incidental cases (p=0.155). Complete resection was achieved in all patients, with no documented recurrences. Two deaths occurred during follow-up (7.1%). Conclusions In this 10-year experience, incidental detection of benign primary cardiac tumours was associated with significantly longer diagnostic and treatment timelines despite similar tumour size. Embolic events occurred exclusively in symptomatic/non-incidental pathways. These findings support structured referral and time-to-treatment pathways to minimise avoidable delays even when tumours are detected incidentally. Incidental discovery should not imply lower priority—benign cardiac tumours warrant timely cardiology referral and expedited evaluation to reduce the risk of preventable embolic complications.