Author:
Michael Kadoch
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MRI Cine SSFP |
MRI T1-weighted precontrast |
MRI T2-weighted |
MRI T1-weighted postcontrast |
NECT |
CECT |
US |
Radiograph |
Gross pathology |
Histology |
Additional comments |
Benign: |
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Myxoma |
Low signal.
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Isointense, heterogeneous. May see point of attachment to atrium.
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Hyperintense, heterogeneous.
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Low to high enhancement. Heterogeneous foci of enhancement.
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Ovoid hypoattenuating atrial mass. May see foci of internal calcification.
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Heterogeneous enhancement.
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Lobular, papillary, heterogeneous, echogenic atrial mass.
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May see a prominent left atrial appendage or a dense ovoid intracardiac calcification. Excised specimens may also demonstrate dense calcifications.
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Firm multilobular mass with a variegated surface. May see calcification or hemorrhage.
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Myxomatous stroma containing abundant hemosiderin. May contain calcification.
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Interauricular septum. Females. 30-60 years old. Mean size 5.7 cm.
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Rhabdomyoma |
Noncontractile areas. (No image available.)
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Iso- or hyperintense. Diffuse heterogeneous nodular thickening of the left ventricular myocardium and interventricular septum.
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Slightly hyperintense. (No image available.)
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Strong. (No image available.)
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Multiple firm white nodules distributed throughout the left ventricular myocardium.
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Vacuolated cells with cytoplasmic streaming artifact that results in "spider cells."
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Left ventricle. Most common primary tumor of the heart in infants and children. Mean size 4 cm. Multiplicity.
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Lipoma |
Hyperintense.
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Hyperintense. Smooth, round, intracavitary mass with signal intensity characteristic of fat.
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Hyperintense.
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Nonenhancing.
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Hypoattenuating. Fat density. (No image available.)
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Hypoattenuating. Fat density. Nonenhancing.
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Echogenic intracavitary mass.
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Well-circumscribed, spherical, yellow mass.
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Any location. Adults. Suppression with fat saturation techniques.
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Fibroma |
Iso- or hyperintense.
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Iso- or hyperintense. Large homogeneous mural mass.
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Hypointense.
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Variable. (No image available.)
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Large mural mass.
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Largely acellular with dense collagen bundles.
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Left ventricle. Children. Mean size 5 cm. Calcification.
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Papillary Fibroelastoma |
Turbulent flow.
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Isointense.
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Hypointense.
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Not published. Here seen as a nonenhancing mass involving the mitral valve.
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May not be seen. Here are 2 cases, one involving the aortic valve and the other involving the mitral valve.
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Nonenhancing. Here seen are 2 cases, one involving the aortic valve and the other involving the mitral valve.
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Echogenic mass.
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Gelatinous, multilobular, papillary mass.
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Left-sided valves (most commonly the aortic valve, followed by the mitral valve). Mean age is 60 years old. Mean size 1 cm. Benign endocardial papillomas.
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Hemangioma |
Intracavitary ventricular mass.
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Isointense. Intracavitary ventricular mass.
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Hyperintense, heterogeneous.
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Strong, heterogeneous.
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Vascular mass. (No image available.) |
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Tan, bosselated mass.
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Characteristic dilated vascular channels interspersed among myocardial cells. Scattered fat cells within the interstitium.
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Any location. Variable population. Small calcifications.
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Paraganglioma |
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Iso- or hypointense. Round, lobular mass.
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Hyperintense. (No image available.)
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Strong. (No image available.)
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Classic nesting appearance of the paraganglial cells.
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Left atrium. 30-40 years old. Paraneoplastic catecholamine syndrome.
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Teratoma |
Variable. (No image available.)
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Large, heterogeneous, lobular, multicystic pericardial mass.
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May see an enlarged cardiac silhouette with a tooth that projects over the heart.
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Firm, white lobular, multilocular cystic mass.
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Neuroretinal (ectodermal) and glandular (endodermal) structures.
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Bronchogenic Cyst |
Hyperintense.
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Hypointense.
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Hyperintense.
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None.
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Interauricular septum. Adults. Differential diagnosis includes hydatid cyst.
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Malignant: |
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Angiosarcoma |
Hypointense foci. (No image available.)
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Isointense with hyperintense areas. (No image available.)
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Iso- to hyperintense. Heterogeneous. Nodular invasive tumor.
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Strong. (No image available.)
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Large, nodular, homogeneous, invasive soft-tissue mass.
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Irregular anastamosing vascular channels lined by atypical endothelial cells.
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Right atrium. Males. 30-50 years old. Possible pericardial origin. Hemorrhage.
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Unclassified sarcoma |
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Isointense. Large invasive mass.
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Isointense. (No image available.)
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Nonspecific. (No image available.)
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Intracavitary soft tissue mass arising from the interventricular septum.
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Intracavitary soft tissue mass arising from the interventricular septum.
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Nodular mass invading the left atrial wall and mitral valve.
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Left atrium. Variable population. Infiltrative or mass-like appearance. Possible pericardial origin.
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Rhabdomyosarcoma |
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Usually isointense. Here seen as a mass arising from the interatrial septum.
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Isointense, heterogeneous. Here seen arising from the myocardial wall of the right ventricle.
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Central nonenhancing areas. (No image available.)
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No predilection for a specific chamber. Hypodense mass arising anywhere in the myocardium, including from the valves (here arising from the left atrium).
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Various textures. Often with areas of central necrosis or cystic degeneration.
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Two main forms seen on analysis: embryonal neoplasms (children and young adults) and adult rhabdomyosarcoma (less common in the heart). (No image available.)
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Any location. Most common cardiac malignancy in infants and children. Necrosis. (No image available.)
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Primary Cardiac Lymphoma |
Hypo- or isointense.
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Hypo- or isointense.
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Hyperintense.
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Variable. Here demonstrating circumferential enhancement.
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Superior vena cavogram may show a large intraluminal tumor that obstructs the vena cava.
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Firm, white, multinodular tumor with plaquelike infiltration and obstruction of the superior vena cava.
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Dark blue round lymphoma cells surrounding and infiltrating residual myocytes.
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Right atrium. Immunocompromised patients. No necrosis. Possible pericardial origin. Rarely intracavitary.
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Osteosarcoma |
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Hyperintense. (No image available.)
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Hyperintense. (No image available.)
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Nonspecific. (No image available.)
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May see dense calcifications associated with a hypodense mass, usually in the left atrium. Calcifications may often be mistaken for benign, dystrophic calcifications.
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Contrast administration helps outline the extent of the tumor, here seen in the left ventricle.
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Pericardial rind and extensive mural involvement. Foci of calcification are also seen.
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Most often arises in the left atrium, versus metastatic osteosarcoma which often arises in the right atrium. Variable population. Calcifications.
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Leiomyosarcoma |
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Isointense. Aggressive mass.
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Hyperintense. (No image available.)
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Nonspecific. (No image available.)
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Nonspecific. Here seen with left atrial enlargement, pulmonary vascular redistribution, and pulmonary interstitial edema with Kerley B lines.
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Left atrium. Variable population. Pulmonary veins and mitral valve involvement.
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Metastasis |
Variable.
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Variable. Here seen as an isointense right atrial mass.
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Variable. Here seen as a hyperintense right atrial mass.
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Variable. Here seen as an enhancing right atrial mass.
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Extremely variable. Here seen are two separate cases of metastatic disease to the heart.
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More common than primary cardiac tumors. Common metastases to the heart and pericardium: lung, lymphoma/leukemia, breast, melanoma, esophageal. Can spread by retrograde lymphatic flow, hematogenously, direct extension, or transvenous extension. RA/RV more commonly involved than LA/LV.
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Tumor-Like: |
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Thrombus |
Hypointense.
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Hypointense, heterogeneous mass.
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Hypointense. (No image available.)
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Typically does not enhance.
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Soft tissue mass. Usually homogeneous in attenuation. May calcify. Here seen are two separate cases of LV apex thrombus.
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Laminated appearance, irregular or lobulated borders, microcavitations, and absence of a pedicle. (No image available.)
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May see atrial or ventricular dilatation. History of indwelling catheter, atrial fibrillation, valvular disease, or prior myocardial infarction with aneurysm formation.
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Valvular vegetations |
Hypointense.
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May see sequelae of the infection. For example, multiple cavitary lung lesions as seen here.
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Pedunculated vegetation may be seen on the valve (here along the mitral valve). May also see perivalvular abscess or associated pseudoaneurysm.
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Hyperechoic, irregular mass usually on the low pressure side of the valve leaflet. See oscillation during the cardiac cycle.
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May see cavitary lung lesions. (No image available.)
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Vegetation seen adherent to the valve (posterior mitral leaflet seen here).
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Predisposing factors for endocarditis include intravenous drug use, poor dental hygiene, long-term hemodialysis, diabetes mellitus, mitral valve prolapse syndrome, and prosthetic valves.
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Lipomatous hypertrophy |
Hyperintense.
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Hyperintense.
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Hyperintense.
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Nonenhancing.
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Wedge-shaped fatty thickening of the interatrial septum. Fatty tissue may extend into the right atrium.
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Interatrial septum. Nonneoplastic accumulation of fat cells. Associated with advancing age and obesity. Can result in supraventricular arrhythmias.
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