Multidetector CT and MR Imaging of Cardiac Tumors

The purpose of this article is to provide a current review of the spectrum of multidetector CT (MDCT) and MRI findings for a variety of cardiac neoplasms. In the diagnosis of cardiac tumors, the use of MDCT and MRI can help differentiate benign from malignant masses. Especially, the use of MDCT is advantageous in providing anatomical information and MRI is useful for tissue characterization of cardiac masses. Knowledge of the characteristic MRI findings of benign cardiac tumors or thrombi can be helpful to avoid unnecessary surgical procedures. Presurgical assessment of malignant cardiac tumors with the use of MDCT and MRI may allow determination of the resectability of tumors and planning for the reconstruction of cardiac chambers

Herztumoren: Haufigkeit, Verteilung, Diagnostik. Anhand von 20.305 Echokardiographien. [Heart tumors: incidence, distribution, diagnosis. Exemplified by 20,305 echocardiographies]

The occurrence, type and location of cardiac tumors as detected by Doppler-echocardiography are reviewed. In a series of 20,305 consecutive echocardiographic studies performed at our institution over a four-year period, cardiac tumors were identified in 30 patients (0.15%; 17 male and 13 female, mean age 53 years). Primary cardiac tumors were detected in 21/30 patients (70%; mean age 50 years), secondary tumors in 5/30 patients (17%; mean age 58 years); however, in 4/30 patients (13%) the tumors could not be classified (mean age 59 years). In the group with primary tumors, benign cardiac tumors were found in 18/21 patients (86%) and malignant tumors in 3/21 (14%). All benign cardiac masses were myxomas (18/18) and accounted for 60% of all tumors; they were mainly located in the left atrium (16/18 or 89%) and rarely occurred in the right atrium (2/18 or 11%). One patient had a recurrence of a left atrial myxoma and a second patient of a biatrial myxoma. Three patients had a primary malignant cardiac tumor detectable either in the right atrium (leiomyosarcoma and synovial sarcoma; 2/21) or in the left ventricle (epitheliocellular sarcoma; 1/21). The group of secondary cardiac tumors consisted of different types of metastatic processes which were most often detected in the right atrium (4/5; 80%) and in one case in the left ventricle (1/5; 20%). Overall, the most frequent tumors found in this series were benign cardiac tumors represented by atrial myxoma in 18/30 patient (60%); they resided most often in the left atrium (16/30 or 53% of all tumors). All the cardiac chambers and all main adjacent cardiac vessels must be visualized and inspected carefully to detect the magnitude, origin and recurrence of cardiac tumors

Predictability of aortic dissection as a function of aortic diameter

The role of aortic diameter on the occurrence of type A dissection was investigated in 73 patients with dilated ascending aorta at the time of pre-operative evaluation. Using transthoracic echocardiography for diagnosis and measurements, 54 patients were identified with type A dissection (group 1) and 19 without dissection (group 2). The true mean aortic diameters were identical (6.0 +/- 1.3 cm in group 1 and 6.4 +/- 1.4 cm in group 2; mean +/- SD; ns) as were the indexed aortic diameters (ratio of diameter/body surface area; 3.2 +/- 0.8 cm.m-2 and 3.4 +/- 0.7 cm.m-2, respectively; ns). However, the individual diameters showed a pronounced scatter in both groups (range from 3.6 +/- 11.0 cm). Of the 73 patients, 66 had surgery (47/54 with and 19/19 without dissection) and seven patients were treated medically. Emergency surgery was performed in 45/66 patients (all with acute type A dissection) and elective repair in 21/66 (19 without and two with chronic type A dissection). In-hospital mortality was 18% in the emergency group, 5% in the elective group and 57% in the medical group. It is concluded that patients with dilated ascending aorta have a substantial incidence of acute dissection. Their clinical course is unpredictable: acute dissection occurs in some, and in others the ascending aorta continues to enlarge without dissection. Because patients with dissection often arrive too late for elective repair and have to be operated on as emergencies with a higher operative risk, we recommend elective surgery before the diameter of the ascending aorta has reached 6 cm