Abnormal structure withing or immediately adjacent to heart
Etiology of cardiac masses are:
1.
2.
3.
4.
1. primary (malignant or benign)
2. secondary mets
3. Thrombus (mass)
4. Vegetations (endocarditis)
Primary benign tumors are MC than primary malignant tumors? T/F
True. Malignant is very bad news
Myxoma is a common benign tumor occuring _________________ of the time.
30%
Symptoms of myxomas are: (5)
Orthopenia
Acute Pulmonary Edema
Cough
Hemoptysis
Palpitations
Explain why BP and murmurs would change with varying patient postions in a patient with a myxoma?
Tumor moves with gravity
List echo findings seen with a myxoma: (4)
Altered IAS (pedunculated) usually on LA side
Texture differs
Mobile - drops through MV in diastole
Mimics MS --> MR event
Complications of Myxoma: (6)
Embolization
Infected myxoma
fever
weight loss
anemia
complications assoc MS & MR
What is the Tx for a myxoma?
immediate surgery
Myxoma's occur in the LA only? T/F
False
LA 75%
LV 4%
RA 18%
RV 4%
List some ways to differentiate a myxoma from thrombus with respect to:
1. mobility
2. borders / surface
3. how attached or based
4. appearance
5. atrial / ventricle dimestions
6. AV valves
7. Location
Myxoma / Thrombus
1. mobile / immobile
2. sharp / irregular perhaps not clearly defined
3. IAS / broad based
4. mottled / layered
5. normal atrial dimension / dilated LV
6. normal AV valve / abnormal AV valve
7. atria (usually) / posterior wall of LA
The MC valvular tumor is __________________ and this tumor rarely exceeds _______________ diameter.
papilary fibroelastoma
1cm
Lipomas are usually found in _____________________ with a ___________________ appearance due to _____________ ________________.
IAS
dumbell
fatty sparing of FO
Fibromas typically present in childhood? T/F
True
MC primary tumor found in children is __________________________.
Rhabdomyoma
MC primary malignant tumor is _____________________?
Explain carcinoid heart disease and echo findings:
Mets carcinoid tumor (usually from appendix or ilium). Tumor mets to liver, seratonin deposited into endocardial lining. Doesn't travel to Lt b/c deactivated by lungs. Looks like TV stenosis and MV will be normal
List 4 types of Thrombi:
1. Layered
2. Pedunculated
3. Multilobulated
4. Single
What is a missile?
Foreign body. Example: knife, bullet, nail
List the normal variants of the RV
1. moderator band
2. trabeculations
3. Catheter
4. Pacemaker wire
Name some normal variants of LV
1. False cord
2. Pap muscles
3. Trabeculations
List some normal variants of RA
1. Chiari network
2. Eustacian valve
3. Crista terminalis
4. Cath / pacemaker
5. Lipomatous hypertrophy IAS
6. Pectinate muscles
7. Fatty material
List some normal variants of the LA
1. Suture line post transplant
2. fossa ovalis
3. Calcified mitral annulus
4. coronary sinus
5. Ridge between LUPV and LAA
6. Lipomatous hypertrophy of IAS
7. Pectinate muscles
8. Transverse sinus
Name benign tumors (5)
Myxoma
Papillary Fibroelastoma
Lipoma
Fibroma
Rhabdomyoma
Malignant tumors would be: (3)
Sarcoma
Angiosarcoma
Mets
Extracardiac tumors are anywhere within the vicinity of the heart. Name 5:
1. Mediastinal cyst
2. Hematoma
3. Thymoma
4. Diaphragmatic Hernia
5. Pancreatic Cyst - pleural tumor
Displacement of heart, compression of cardiac chambers, SVC obstruction, tamponade, constrictive pericarditis, PS or TS may be the result of an _____________________ ____________________.
Extracardiac tumor
Normal variant of AO valve include? (2)
1. Lambl's Excrescence
2. Nodule of Arantus
The 3 basic types of cardiac masses are:
1. Tumor
2. Thrombus
3. Vegetation
Marantic endocarditis is ______________ ________________ ________________.
nonbacterial thrombotic endocarditis
Nonprimary cardiac tumors are approx ______________ more common than primary cardiac tumors.
20X
Nonprimary cardiac tumors can affect the heart by invasion of the __________________, production of __________________ active substances, and have a ________________ effect of treatment on the heart.
pericardium
biologically
toxic
Differential Dx of PE in patient with known malignancy could include: (3)
1. radiation pericarditis
2. idiopathic pericarditis
3. mets
What percentage of cardiac tumors are benign?
75%
Primary tumors in order of frequency are:
1.
2.
3.
4.
5.
1. Myxoma
2. Lipoma
3. Papillary Fibroelastoma
4. Hemangioma
5. Mesothelioma
Thrombus formation in the LV tends to occur in regions of __________ __________ or ______________ ______________ _______________ _______________.
Blood stasis
low velocity blood flow
Thrombus formation also often accompanies a LV __________________.
pseudoaneurysm
How can Doppler help with LV thrombus?
ID flow presence
List 3 techniques that help ID thrombus: (3)
1. TEE
2. contrast angio
3. radionuclide
Which type of thrombus has a higher embolic potential?
protruding
LA thrombus are associated with: (3)
1.
2.
3.
1. LAE
2. MV disease
3. A-fib
The highest incidence of LA thrombus is in patients with _____________________ & _________________.
Rheumatic MS & Afib
Formation of thrombus in the Rt side of heart is rare: T/F
True
What should the sonographer be thinking when you see Rt heart thrombus?
Mets
Define: Atheroma
Fatty deposit in intima
A patent foramen ovale is present in ________ to ________ % of patients.
25-35%
How can PFO best be evaluated?
TEE - probe inserted into esophagus
IAS aneurysm is a transient ___________________ of fossa ovalis region > ________ mm in the absence of chronic increase of LA or RA __________________.
bulging
15
pressure
Spontaneous contrast is:
In the LA there is stasis blood flow creating a "cloud smoke" appearance.