Sandbox: table diagnosis myxoa: Difference between revisions

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The table below summarizes the findings that differentiate [[Cardiac Myxoma]] from other conditions that cause [[Emboli]] and [[hemorrhage]]:


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! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Imaging Technique}}
! style="background: #4479BA; width: 100px;" | {{fontcolor|#FFF|Imaging Technique}}
! style="background: #4479BA; width: 600px;" | {{fontcolor|#FFF|Features}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Features}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Description}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Description}}
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Advantages/Disadvantages}}
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Advantages}}
! style="background: #4479BA; width: 600px;" | {{fontcolor|#FFF|Limitations}}
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|Limitations}}


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| style="padding: 5px 5px; background: #DCDCDC;" align=center|Two- or three-dimensional echocardiography
| 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. Moreover, echocardiography can be useful to assess the mobility of the tumor, as it often protrude through valve flaps.
| style="padding: 5px 5px; background: #F5F5F5;" align=center|Echocardiography is usually the initial modality used for identification and evaluation of cardiac myxomas<ref name="pmid7304443">{{cite journal |vauthors=Come PC, Riley MF, Markis JE, Malagold M |title=Limitations of echocardiographic techniques in evaluation of left atrial masses |journal=Am. J. Cardiol. |volume=48 |issue=5 |pages=947–53 |year=1981 |pmid=7304443 |doi= |url=}}</ref>
| style="padding: 5px 5px; background: #F5F5F5;" align=center|They appear as hyperechogenic lesions with a well-defined stalk,the tumor tends to protrude into the left ventricle (LV) in the case of left atrial myxoma.  
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| style="padding: 5px 5px; background: #F5F5F5;" align=center| Both transesophageal and transthoracic echocardiography provide only 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> Transesophageal echocardiography is an invasive imaging technique. TT modality can be affected by the acustic window.
*Hyperechogenic lesions with a well-defined stalk
*Protrusion into the ventricles is a common finding
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*Real-time imaging
*Tumor mobility and distensibility
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*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
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| style="padding: 5px 5px; background: #DCDCDC;" align=center|MRI
| style="padding: 5px 5px; background: #DCDCDC;" align=center|MRI
| style="padding: 5px 5px; background: #F5F5F5;" align=center|CMR imaging plays a significant role in the 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|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.
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T1: tend to be low to intermediate signal, but areas of haemorrhage may be high
*Cardiac myxomas appear spherical or ovoid with lobular contours, irregular in shape
T2: can be variable due to heterogeneity in tumour componants; e.g calcific components > low signal; myxomatous components  > high signal
*'''T1''' : Low to intermediate signal, but areas of hemorrhage may be high
GE (gradient echo): may show blooming of calcific components
*'''T1 C+ (Gd)''': shows enhancement (important discriminator from a thrombus) demonstrates uniform heterogeneous enhancement.
T1 C+ (Gd): shows enhancement (important discriminator from a thrombus) demonstrates uniform heterogeneous enhancement.
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
| style="padding: 5px 5px; background: #F5F5F5;" align=center|D
* MRI allows imaging in multiple planes
| style="padding: 5px 5px; background: #F5F5F5;" align=center| MRI cannot show calcification, and has a high susceptibility to motion artifact. CMR imaging is highly dependent on regular electrocardiographic rhythms and cardiac gating.
* Provides some functional information such as, flow direction and flow velocity in large vessels
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*Cannot show calcification
*High susceptibility to motion artifact
*Dependent on regular electrocardiographic rhythms and cardiac gating
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| style="padding: 5px 5px; background: #DCDCDC;" align=center|CT
| style="padding: 5px 5px; background: #DCDCDC;" align=center|CT
| style="padding: 5px 5px; background: #F5F5F5;" align=center|CT can be used to accurately image the heart and surrounding mediastinum
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| style="padding: 5px 5px; background: #F5F5F5;" align=center|Intracardiac heterogeneously low attenuating mass. The attenuation is usually lower than that of myocardium, coarse dystrophic calcification is common.
*Intracardiac heterogeneously low attenuating mass
| style="padding: 5px 5px; background: #F5F5F5;" align=center|D
*The attenuation is usually lower than that of myocardium
| style="padding: 5px 5px; background: #F5F5F5;" 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.
*Calcification is common
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*CT provides better soft-tissue contrast
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*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
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| style="padding: 5px 5px; background: #DCDCDC;" align=center|Angiography
| 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|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|
| style="padding: 5px 5px; background: #F5F5F5;" align=center|D
*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|E
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*Angiography can detect the concomitant coronary disease and the unique vascular appearances of cardiac myxoma
*Helpful for surgical evaluation
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*Invasive imaging technique
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| style="padding: 5px 5px; background: #DCDCDC;" align=center|Chest x-ray
| 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|Chest x-ray has no particular findings associated with cardiac myxoma
| style="padding: 5px 5px; background: #F5F5F5;" align=center|Results can be normal. Common findings include cardiomegaly, left atrial enlargement, vascular redistribution, prominent pulmonary trunk, and intracardiac tumoral calcification(rare).
| style="padding: 5px 5px; background: #F5F5F5;" align=center|
| style="padding: 5px 5px; background: #F5F5F5;" align=center|D
*Results can be normal
| style="padding: 5px 5px; background: #F5F5F5;" align=center|E
| 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
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Latest revision as of 13:41, 30 November 2015

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[1]
  • 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[2]
  • 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
  1. Come PC, Riley MF, Markis JE, Malagold M (1981). "Limitations of echocardiographic techniques in evaluation of left atrial masses". Am. J. Cardiol. 48 (5): 947–53. PMID 7304443.
  2. Reeder GS, Khandheria BK, Seward JB, Tajik AJ (1991). "Transesophageal echocardiography and cardiac masses". Mayo Clin. Proc. 66 (11): 1101–9. PMID 1943240.