Cardiac tumours: diagnosis and management

Patients with cardiac tumours may present with cardiovascular related or constitutional symptoms, but more often than not a cardiac mass is discovered incidentally during an imaging examination performed for an unrelated indication. These incidental masses usually represent thrombi or vegetations, often occurring in a particular clinical milieu.1 If a mass is indeed a tumour, it is most likely malignant secondary to a known malignant process elsewhere, usually from the breast, lung or malignant melanoma. Much less likely, the mass represents a primary cardiac tumour. In this case it is most likely benign, with a nearly 50% likelihood of being a myxoma. Malignant primary cardiac tumours are exceedingly rare and represent only approximately a quarter of primary cardiac tumours. These are most often a variety of sarcoma. Although primary cardiac tumours are rare with an autopsy frequency of only 0.001–0.03%,2 they represent an important group of cardiovascular abnormalities because early and accurate diagnosis may be curative and sometimes avoids unnecessary surgery.1 3 Echocardiography is an ideal initial imaging modality since it is simple, non-invasive, widely available, and low cost. It delineates the morphologic appearance, location and motion of tumours as well as determining the haemodynamic consequences of the tumour, if any. CT and MRI are complimentary techniques that provide additional diagnostic information4 and are useful for staging and treatment planning, particularly when surgical resection is being considered. CT has better spatial resolution than MRI and also provides information about vascularity and calcification. MRI also provides information about vascularity, has better overall tissue characterisation, and does not have the attendant risk of radiation. Clinical symptoms and signs are often determined by location of the tumour rather than its histologic type. Thus, the clinical significance of a ‘benign’ tumour may be just as important as a ‘malignant’ type. Benign …