Myxoma CT

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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.[1] 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.[2]

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.[3]

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

CT scan show low attenuation and areas of dystrophic calcification



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.[4]
  • 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. Schoepf UJ. CT of the Heart, Principles and Applications.Springer Science & Business Media; 2007
  2. 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.
  3. Left atrial myxoma Dr Ian Bickle Radiopedia.org 2015 http://radiopaedia.org/cases/left-atrial-myxoma
  4. 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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