Thrombi are the most frequent cause of an intracardiac mass. Myxomas make up nearly 50% of the benign tumors and the majority of the rest are lipomas, papillary fibroelastomas, and rhabdomyomas. Fibromas, hemangiomas, teratomas, and mesotheliomas of the atrioventricular node are found less frequently; granular-cell tumor, neurofibromas, and lymphangiomas are very rare. Hydatid cyst can also have an intracardiac location. Metastatic tumors to the heart are about 20 times more common when compared to primary malignant cardiac tumors. Breast, lung, melanoma, and lymphoma are the most common neoplasms to metastasize to the heart. Angiosarcoma is the most common primary malignant cardiac tumor, followed by rhabdosarcoma, liposarcoma, and other sarcomas.
Differential Diagnosis of a Cardiac Mass
- Primary benign tumors
- Primary malignant tumors
- Metastatic tumors
Lipomatous hypertrophy, moderator bandsand papillary muscles may simulate cardiac masses.
Embolism occurs in 30-40% of patients with myxoma. The other typical symptoms include cardiac obstruction and constitutional complaints. The treatment of choice is surgical resection. However this patient is asymptomatic and not a good candidate for surgical resection because of her comorbidities (bypass grafting of the coronary arteries as well as bypass of the obstructed native left common carotid artery and brachiocephalic artery). A decision was made to manage her conservatively with yearly cardiac CT to evaluate for signs of rapid growth or cardiac obstruction.
1. Brant W. and Helms C. (2007) Fundamentals of Diagnostic Radiology, Lippincott Williams & Wilkins p 645-648.
2. Reynen, K. (1995) Review Articles: Cardiac Myxomas. The New England Journal of Medicine. December 14, 1995: 1610-1617.