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