Myxoma CT: Difference between revisions

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==Overview==
==Overview==
On myxoma CT scan is characterised by low attenuation and areas of [[dystrophic calcification]] in cardiac chambers.
On cardiac myxoma, CT scan is characterized by low attenuation and areas of [[dystrophic calcification]] in cardiac chambers. CT scan may be helpful in the diagnosis of cardiac myxoma, because it provides better soft-tissue contrast than echocardiography, and it can also differentiate calcification and fat, and may allow tissue diagnosis of some masses such as lipomas.
<ref>Schoepf UJ. CT of the Heart, Principles and Applications. Springer Science & Business Media; 2007</ref>


==Key CT scan Findings in Myxoma==
==Key CT scan Findings in Myxoma==
CT scan show  low attenuation and areas of [[dystrophic calcification]] in cardiac chambers:<ref name=radio>Left atrial myxoma  Dr Ian Bickle Radiopedia.org 2015 http://radiopaedia.org/cases/left-atrial-myxoma</ref>


==Gallery==
Cardiac myxomas appear as intra-cardiac masses, most often in the left atrium and attached to the [[interatrial septum]]. They are usually heterogeneously low attenuating (approximately two-thirds of cases). Due to repeated episodes of haemorrhage, [[dystrophic calcification]] is common.<ref name="pmid10555666">{{cite journal |vauthors=Araoz PA, Eklund HE, Welch TJ, Breen JF |title=CT and MR imaging of primary cardiac malignancies |journal=Radiographics |volume=19 |issue=6 |pages=1421–34 |year=1999 |pmid=10555666 |doi=10.1148/radiographics.19.6.g99no031421 |url=}}</ref><ref>Schoepf UJ. CT of the Heart, Principles and Applications.Springer Science & Business Media; 2007</ref>


[[File:Left-atrial-myxoma.jpg|CT scan show  low attenuation and areas of [[dystrophic calcification]] |center|thumb|200px]].
The contrast–enhanced chest CT findings in cardiac myxoma include:
 
* Low attenuating heterogeneous intracardiac mass
* Spherical or ovoid intracavitary mass
* Dystrophic calcifications
 
==CT Examples of Cardiac Myxoma==
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+
! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF|Imaging Technique}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Features}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Description}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Advantages}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Limitations}}
 
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''Two- or three-dimensional echocardiography'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
*Echocardiography is usually the initial modality used for identification and evaluation of cardiac myxomas.
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
*Hyperechogenic lesions with a well-defined stalk.
*Protrusion into the ventricles is a common finding.
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
*Real-time imaging
*Tumor mobility and distensibility.
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
*Limited views of the mediastinum and cannot be used to evaluate extracardiac manifestations of disease.<ref name="pmid1943240">{{cite journal |vauthors=Reeder GS, Khandheria BK, Seward JB, Tajik AJ |title=Transesophageal echocardiography and cardiac masses |journal=Mayo Clin. Proc. |volume=66 |issue=11 |pages=1101–9 |year=1991 |pmid=1943240 |doi= |url=}}</ref>
*TEE is an invasive imaging technique.
*TT is limited by the imaging window, which can vary with the patient and operator experience.
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''MRI'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
*Evaluation of cardiac masses and is of greatest value when echocardiographic findings are suboptimal or when the lesion has an atypical location or appearance.
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
*Cardiac myxomas appear spherical or ovoid with lobular contours, irregular in shape.
*'''T1''' : Low to intermediate signal, but areas of hemorrhage may be high.
*'''T1 C+ (Gd)''': shows enhancement (important discriminator from a thrombus) demonstrates uniform heterogeneous enhancement.
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
* MRI allows imaging in multiple planes.
* Provides some functional information such as, flow direction and flow velocity in large vessels.
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
*Cannot show calcification.
*High susceptibility to motion artifact.
*Dependent on regular electrocardiographic rhythms and cardiac gating.
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''CT'''
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |
*CT can be used to accurately image the heart and surrounding mediastinum.
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |
*Intracardiac heterogeneously low attenuating mass.
*The attenuation is usually lower than that of myocardium.
*Calcification is common
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |
*CT provides better soft-tissue contrast.
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |
*There is no real-time true imaging with CT and imaging planes are limited to those allowed by angulation of the gantry.
*There is no evaluation of small moving structures, such as the cardiac valves.
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''Angiography'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
*Coronary angiography may be helpful to detect vascular supply of the tumor by the coronary arteries.
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
*The angiographic findings of cardiac myxoma demonstrate feeding vessels, contrast medium poolings, and clusters of tortuous vessels that correspond to tumor vasculature
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
*Angiography can detect the concomitant coronary disease and the unique vascular appearances of cardiac myxoma.
*Helpful for surgical evaluation.
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
*Invasive imaging technique
|-
| style="padding: 5px 5px; background: #DCDCDC;" align="center" |'''Chest x-ray'''
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
*Chest x-ray has no particular findings associated with cardiac myxoma.
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
*Results can be normal.
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
*Low cost
*May be helpful, if calcifications present.
| style="padding: 5px 5px; background: #F5F5F5;" align="center" |
*Does not provide a diagnosis.
|-
 
|}


==References==
==References==
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[[Category:Disease]]
[[Category:Disease]]
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Cardiology]]
[[Category:Surgery]]

Latest revision as of 22:28, 13 June 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ahmad Al Maradni, M.D. [2]Maria Fernanda Villarreal, M.D. [3]

Overview

On cardiac myxoma, CT scan is characterized by low attenuation and areas of dystrophic calcification in cardiac chambers. CT scan may be helpful in the diagnosis of cardiac myxoma, because it provides better soft-tissue contrast than echocardiography, and it can also differentiate calcification and fat, and may allow tissue diagnosis of some masses such as lipomas.

Key CT scan Findings in Myxoma

Cardiac myxomas appear as intra-cardiac masses, most often in the left atrium and attached to the interatrial septum. They are usually heterogeneously low attenuating (approximately two-thirds of cases). Due to repeated episodes of haemorrhage, dystrophic calcification is common.[1][2]

The contrast–enhanced chest CT findings in cardiac myxoma include:

  • Low attenuating heterogeneous intracardiac mass
  • Spherical or ovoid intracavitary mass
  • Dystrophic calcifications

CT Examples of Cardiac Myxoma

Imaging Technique Features Description Advantages Limitations
Two- or three-dimensional echocardiography
  • Echocardiography is usually the initial modality used for identification and evaluation of cardiac myxomas.
  • Hyperechogenic lesions with a well-defined stalk.
  • Protrusion into the ventricles is a common finding.
  • Real-time imaging
  • Tumor mobility and distensibility.
  • Limited views of the mediastinum and cannot be used to evaluate extracardiac manifestations of disease.[3]
  • TEE is an invasive imaging technique.
  • TT is limited by the imaging window, which can vary with the patient and operator experience.
MRI
  • Evaluation of cardiac masses and is of greatest value when echocardiographic findings are suboptimal or when the lesion has an atypical location or appearance.
  • Cardiac myxomas appear spherical or ovoid with lobular contours, irregular in shape.
  • T1 : Low to intermediate signal, but areas of hemorrhage may be high.
  • T1 C+ (Gd): shows enhancement (important discriminator from a thrombus) demonstrates uniform heterogeneous enhancement.
  • MRI allows imaging in multiple planes.
  • Provides some functional information such as, flow direction and flow velocity in large vessels.
  • Cannot show calcification.
  • High susceptibility to motion artifact.
  • Dependent on regular electrocardiographic rhythms and cardiac gating.
CT
  • CT can be used to accurately image the heart and surrounding mediastinum.
  • Intracardiac heterogeneously low attenuating mass.
  • The attenuation is usually lower than that of myocardium.
  • Calcification is common
  • CT provides better soft-tissue contrast.
  • There is no real-time true imaging with CT and imaging planes are limited to those allowed by angulation of the gantry.
  • There is no evaluation of small moving structures, such as the cardiac valves.
Angiography
  • Coronary angiography may be helpful to detect vascular supply of the tumor by the coronary arteries.
  • The angiographic findings of cardiac myxoma demonstrate feeding vessels, contrast medium poolings, and clusters of tortuous vessels that correspond to tumor vasculature
  • Angiography can detect the concomitant coronary disease and the unique vascular appearances of cardiac myxoma.
  • Helpful for surgical evaluation.
  • Invasive imaging technique
Chest x-ray
  • Chest x-ray has no particular findings associated with cardiac myxoma.
  • Results can be normal.
  • Low cost
  • May be helpful, if calcifications present.
  • Does not provide a diagnosis.

References

  1. Araoz PA, Eklund HE, Welch TJ, Breen JF (1999). "CT and MR imaging of primary cardiac malignancies". Radiographics. 19 (6): 1421–34. doi:10.1148/radiographics.19.6.g99no031421. PMID 10555666.
  2. Schoepf UJ. CT of the Heart, Principles and Applications.Springer Science & Business Media; 2007
  3. Reeder GS, Khandheria BK, Seward JB, Tajik AJ (1991). "Transesophageal echocardiography and cardiac masses". Mayo Clin. Proc. 66 (11): 1101–9. PMID 1943240.


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