 |
| Fig. 30 |
Echocardiography
is now the principle method for the diagnosis of cardiac tumors.
As discussed in a previous unit in this series, myxomas are frequently
intracavitary and may occur in any cardiac chamber. (Fig. 30) demonstrates
a myxoma occurring on the tip of the anterior mitral valve leaflet
of an asymptomatic individual (who had an echocardiographic study
as a part of an insurance physical).
 |
| Fig. 31 |
There is, however, nothing specific about the echocardiographic
appearance to identify the tumor.(Fig. 31) shows a left atrial tumor,
attached to the posterior wall of the left atrium that on surgical
resection was found to be an angiosarcoma. Since myxomas are most
commonly attached to the interatrial septum, only its location on
the posterior atrial wall indicated that it was unlikely to be a
myxoma.
 |
| Fig. 32 |
Not all tumors are primary to the heart. (Fig. 32) shows a short
axis of the aortic root with a massive tumor in the right atrium,
protruding through the tricuspid valve orifice in diastole. This
was found in a patient with diffusely metastatic melanoma who had
a heart murmur noted on physical examination prior to chemotherapy.
The patient had recently become intermittently dyspneic on exertion.
The tumor was surgically removed to palliate symptoms
Metastatic tumors are most commonly intramyocardial and may be manifest
as localized thickening within the myocardium. Such tumors can affect
contractility or they may impinge upon the various cavities of the
heart and obstruct flow.
 |
| Fig. 33 |
However, primary tumors of the myocardium can occur. The most common
tumor of children is a rhabdomyoma. (Fig. 33) shows a rhabdomyoma
of the posterior left ventricular wall in a 14 year old. As with
tumors elsewhere in the body, a tissue diagnosis is necessary for
absolute certainty of the nature of the mass lesion.
 |
| Fig. 34 |
Certain extracardiac tumors may affect the heart and be noted by
echocardiography. Intrathoracic tumors of any origin can compress
the cardiac chambers from outside the heart. Renal cell carcinoma
may grow into the renal vein and thus into the inferior vena cava,
obstructing venous inflow (Fig. 34).
Echocardiography is now the method of choice in identifying the
presence and extent of both intracavitary and intramural tumors.
Cardiac catheterization rarely adds diagnostic or more detailed
anatomic information concerning these mass lesions. It is now widely
accepted that surgical decisions can be based on the clinical situation
and echocardiographic data.
2004