Dr. Ciltalic Martínez. Cardiologis & Cardiac Imaging. INCICH, México.
Dr. Roberto Cano. Pediatric Cardiologist & Cardiac Imaging. INCICH, México.
Female, 71 years old. High blood pressure and type 2 DM. Dyspnea, coughing and nausea 3 months before arriving to the hospital. Deterioratio of NYHA within 2 months.
BP: 170/90 RC: 100 RR: 28 Temp 37 ºC Sat: 65% air atmosphere. Rhythmic heart sounds good intensity, mitral stenosis murmur, bilateral crackles lung fields. Treatment was initiated for heart failure which showed improvement.
Laboratory: Hb: 10.8 g / dL HCT: 33.7% leukocytes: 9,400 cells / ml platelets 77,000 cells / ml Glu: 293 mg / dl proBNP: 2926 pg / ml.
Video 1. MRI. SSFP sequence. Four chambers view. Left atrium tumors . Protruding to the left ventricle in diastole.
Video 2. MRI. SSFP sequence. Two left chambers view. Lest atrium tumors. The mayor tumor protruding to the left ventricle.
Video 3. MRI First pass perfusion. Four chambers view. Hypointense of tumors
Video 4. MRI First pass perfusion. Two left chambers view. Hypointense of tumors.
Cardiac MRI. According to the behavior in the sequences the possibility of diagnosis was multiple myxoma vs undifferentiated sarcoma.
Histopathological study reported was undifferentiated sarcoma.
Cardiac tumors represent a cause of significant morbidity and mortality. The therapeutic approach differs according to the etiology of cardiac mass (tumor vs. non-tumor) and type of tumor (benign vs malignant), so that CMR is considered the imaging modality of choice to evaluate cardiac masses. To determine with high accuracy the tissue morphology characterization and tumor perfusion.
Primary malignant cardiac tumors are very rare <10%. 95% of these cancers are sarcomas and the rest are lymphomas or mesotheliomas. Sarcomas occur most frequently in adults being the most common angiosarcoma. The findings on MRI are large heterogeneous mass with or without pericardial get involved; in sequences T1 and T2 intensity of heterogeneous, reflecting tumor histology of necrosis and hemorrhage, there capturing the first step by heterogeneous reinforcement vascularity and investment recovery sequence.
Rhabdomyosarcomas happens 20% of sarcomas and occur most often in children involving multiple sites in the heart, in the RMC behave isointense on T1, hyperintense on T2 and heterogeneous enhancement.
Cardiac sarcoma without characteristic histological pattern is classified as undifferentiated, they occur one third of cardiac sarcomas and are the second heart primary malignant tumor, in the sequences of RMC are similar to angiosarcoma behavior, but has a predilection for the left atrium by 81 %.
1.Manish Motwani, MB ChB Ananth Kidambi, BM. MR Imaging of Cardiac Tumors and Masses: A Review of Methods and Clinical Applications. RSNA, 2013.
2.Sandra Fussen, Bart W.L. De Boeck. Cardiovascular magnetic resonance imaging for diagnosis and clinical management of suspected cardiac masses and tumours. European Heart Journal (2011) 32, 1551–1560