Login Here · Help ·
Public User
2X
| Home->COTW AMA Category 1 Credit for Physicians Only. ASRT CME is not available. |
Go to the COTW Archive |
|
Case-of-the-Week Information
|
|
The TEE showed a mass in the LVOT that appeared to be attached to the anterior mitral valve. Specifically, the mass appeared to be attached near A3. The LVEF was 50%. The wall motion was normal. There was mild aortic insufficiency. There was minimal turbulence in the LVOT. The AR jet appeared to be directed towards the mass. The aortic valve had Lambl's Excressences Tumors of the heart are separated into different classifications: Benign Malignant Benign tumors occur in 80% of the tumors of the heart and are: Myxoma 27% Lipoma 10% Papillary Fibroelastoma 10% Hemangioma 3% Mesothelioma of the AV Node 1% Cysts can also occur in the following incidence: Pericardial Cyst 18% Bronchogenic Cyst 2% The most common benign tumor is a myxoma. Myxomas typically occur upstream side of the valve. Myxomas can be large, have a ground-glass consistency, are irregular, mobile, have a stalk (some are very long or very short), and are pliable. Myxomas can exhibit emboli phenomena or cause obstructive symptoms (syncope). Myxoma Locations: LA 75% RA 18% LV 4% RV 4% Multiple 5% Myxomas can also be part of the Carney Complex: Mutiple lentigines and blue nevi Peripheral myxoid tumors Psamommatous melanotic schwannoma Endocrine over activity Cushingâ‚Ǩ‚Ñ¢s Syndrome Pituitary Adenomas Testicular Sertoli cell tumors Multiple Recurrent Cardiac Masses The Carney Complex is familial/autosomal dominant. Fibroelastomas are the second most common tumor and typically occurs on the downstream side of a valve. Fibroelastomas arise from valvular tissue and are histologically similar to Lambl's Excressence. Fibroelastomas are usually small, and mobile. A fibroelastoma usually appears as a cauliflower or frond-like tumor. On echocardiography it appears to be similar to a sea anemone. Fibroelastomas can have pieces break off and embolize or the whole tumor can embolize. Fibroelastomas can be confused with vegetations. Vegetations are usually on the upstream side of a valve. Lipomatous hypertrophy of the atrial septum can occur. Usually the superior and inferior portions of the septum have lipomatous deposition and the fossa ovalis is spared making the atrial septum appear as a bow-tie. Occasionally the fossa ovalis exhibits rings of limpoatous depostions. Malignant tumors of the heart comprise 20% of the cardiac tumors. Local invasion or metastastic tumors are: Lung Liver Breast Leukemia Stomach Melanoma Lymphoma (AIDS) Colon Primary cardiac malignancies are: Angiosarcoma 9% Rhabdomyosarcoma 5% Mesothelioma 4% Fibrosarcoma 3% Malignant Lymphoma 2% Extraskeletal Osteosarcoma 1% Other tumors invade the heart via the venous system are are: Renal Cell Carcinoma Uterine Leiomyosarcoma Lastly, tumors can affect the heart by production of neuroendocrine substances such as: Carcinoid Tumors Pheochromocytoma For this case, while the pathology came back as a fibroelastoma the intraoperative image if the tumor did not have the typical fond-like appearance of a fibroelastoma. Refs: Braunwald's Heat Disease Clinical Echocardiography |
| Please answer the following questions correctly to obtain your CME. |
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of University of Nebraska Medical Center, Center for Continuing Education and JLS Interactive, LLC.
This activity is approved by the American Society of Radiologic Technologists (ASRT) as sonography-related continuing education (CE). Credit(s) issued for successful completion of ASRT-approved CE activities are accepted by the American Registry of Diagnostic Medical Sonography, American Registry of Radiological Technologists, Cardiovascular Credentialing International and Canadian Association of Registered Diagnostic Ultrasound Professionals. Contact the applicable registry for additional information / restrictions on their acceptance of ASRT CE credit.
= GIF Image
= JPG Image