Cardiac Masses

Benign Masses (75%)

  • Myxoma

  • Firboelastoma

  • Fibroma

  • Paraganglioma (very rare)

  • Lipoma

  • Hemangioma

  • Teratoma (very rare)

Malignant Masses (25%)

  • Sarcoma

    • Angiosarcoma (Adults)

    • Rhabdomyosarcoma (Kids)

  • Lymphoma

  • Mesothelioma

Myxomas

  • Mostly adults

  • 75% in LA, 25% in RA

  • Typically asymptomatic

    • Fibrous type may cause obstruction

    • Myxoid type may cause embolus

  • Imaging findings

    • Smooth or lobulated

    • Heterogenous

    • Isointense (to mildly hyper) to muscle on MR

    • Can have calcifications

    • Secondary signs of obstruction

Papillary Fibroelastoma

  • Adults

  • Typically asymptomatic

  • Do not reocur after excision

  • Imaging findings

    • Small mobile mass

    • < 2cm

    • Commonly on Aortic or Mitral Valve

Rhabdomyomas

  • Infants and children

  • 50% of cases associated with Tuberous sclerosis

  • Most will spontaneously regress, therefore only treated if have severe symptoms

  • Imaging findings

  • Mass invasing ventricular lumen or have diffuse myocardial thickening

  • Isointense to myocardium on T1

  • Hyperintense on T2

Cardiac Fibroma

  • Mural mass commonly with calcifications

  • Iso to hyper on T1

  • Hypointense on T2

Hemangioma

  • Intracavitary mass in any chamber or in pericardium

  • Strong enhancement

  • Variable on T1

  • Hyperintense on T2

Cardiac Lipoma

  • Non-mobile

  • Do not enhance

  • Homogenous, may have septa

Atrial Septal Lipomatosis

  • ?

Sarcoma

  • Angiosarcoma

  • Adults

  • 80% in RA and affect the pericardium

  • Can cause RV obstruction and/or tamponade

  • Poor prognosis (<1 year)

  • Imaging findings

    • Broad based mass involving myocardium

    • Highly vascular

    • Heterogenous

    • Enhancing

    • Variable on T1

    • Hyperintense on T2

Pericardial Meothelioma

  • Related to asbestos

  • Poor prognosis

Primary Cardiac Lymphoma

  • Seen in immunocompromised

Cardiac Mets

  • Most commonly from lung, breast and lymphoma

  • Melanoma loves to met to the pericardium but is a less common overall cancer than those above and therefore is not one of the most common causes

  • Affect epicardium (visceral pericardium)

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