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A cardiac mass can be defined as:
Abnormal structure withing or immediately adjacent to heart
Etiology of cardiac masses are:
- 1. primary (malignant or benign)
- 2. secondary mets
- 3. Thrombus (mass)
- 4. Vegetations (endocarditis)
Primary benign tumors are MC than primary malignant tumors? T/F
True. Malignant is very bad news
Myxoma is a common benign tumor occuring _________________ of the time.
Symptoms of myxomas are: (5)
- Acute Pulmonary Edema
Explain why BP and murmurs would change with varying patient postions in a patient with a myxoma?
Tumor moves with gravity
List echo findings seen with a myxoma: (4)
- Altered IAS (pedunculated) usually on LA side
- Texture differs
- Mobile - drops through MV in diastole
- Mimics MS --> MR event
Complications of Myxoma: (6)
- Infected myxoma
- weight loss
- complications assoc MS & MR
What is the Tx for a myxoma?
Myxoma's occur in the LA only? T/F
- LA 75%
- LV 4%
- RA 18%
- RV 4%
List some ways to differentiate a myxoma from thrombus with respect to:
2. borders / surface
3. how attached or based
5. atrial / ventricle dimestions
6. AV valves
Myxoma / Thrombus
- 1. mobile / immobile
- 2. sharp / irregular perhaps not clearly defined
- 3. IAS / broad based
- 4. mottled / layered
- 5. normal atrial dimension / dilated LV
- 6. normal AV valve / abnormal AV valve
- 7. atria (usually) / posterior wall of LA
The MC valvular tumor is __________________ and this tumor rarely exceeds _______________ diameter.
- papilary fibroelastoma
Lipomas are usually found in _____________________ with a ___________________ appearance due to _____________ ________________.
- fatty sparing of FO
Fibromas typically present in childhood? T/F
MC primary tumor found in children is __________________________.
MC primary malignant tumor is _____________________?
Secondary metastatic tumors arise from (5):
- 1. Leukemia
- 2. Lymphoma
- 3. Lung Ca
- 4. Melanoma
- 5. Breast Ca
Explain carcinoid heart disease and echo findings:
Mets carcinoid tumor (usually from appendix or ilium). Tumor mets to liver, seratonin deposited into endocardial lining. Doesn't travel to Lt b/c deactivated by lungs. Looks like TV stenosis and MV will be normal
List 4 types of Thrombi:
- 1. Layered
- 2. Pedunculated
- 3. Multilobulated
- 4. Single
What is a missile?
Foreign body. Example: knife, bullet, nail
List the normal variants of the RV
- 1. moderator band
- 2. trabeculations
- 3. Catheter
- 4. Pacemaker wire
Name some normal variants of LV
- 1. False cord
- 2. Pap muscles
- 3. Trabeculations
List some normal variants of RA
- 1. Chiari network
- 2. Eustacian valve
- 3. Crista terminalis
- 4. Cath / pacemaker
- 5. Lipomatous hypertrophy IAS
- 6. Pectinate muscles
- 7. Fatty material
List some normal variants of the LA
- 1. Suture line post transplant
- 2. fossa ovalis
- 3. Calcified mitral annulus
- 4. coronary sinus
- 5. Ridge between LUPV and LAA
- 6. Lipomatous hypertrophy of IAS
- 7. Pectinate muscles
- 8. Transverse sinus
Name benign tumors (5)
- Papillary Fibroelastoma
Malignant tumors would be: (3)
Extracardiac tumors are anywhere within the vicinity of the heart. Name 5:
- 1. Mediastinal cyst
- 2. Hematoma
- 3. Thymoma
- 4. Diaphragmatic Hernia
- 5. Pancreatic Cyst - pleural tumor
Displacement of heart, compression of cardiac chambers, SVC obstruction, tamponade, constrictive pericarditis, PS or TS may be the result of an _____________________ ____________________.
Normal variant of AO valve include? (2)
- 1. Lambl's Excrescence
- 2. Nodule of Arantus
The 3 basic types of cardiac masses are:
- 1. Tumor
- 2. Thrombus
- 3. Vegetation
Marantic endocarditis is ______________ ________________ ________________.
nonbacterial thrombotic endocarditis
Nonprimary cardiac tumors are approx ______________ more common than primary cardiac tumors.
Nonprimary cardiac tumors can affect the heart by invasion of the __________________, production of __________________ active substances, and have a ________________ effect of treatment on the heart.
Differential Dx of PE in patient with known malignancy could include: (3)
- 1. radiation pericarditis
- 2. idiopathic pericarditis
- 3. mets
What percentage of cardiac tumors are benign?
Primary tumors in order of frequency are:
- 1. Myxoma
- 2. Lipoma
- 3. Papillary Fibroelastoma
- 4. Hemangioma
- 5. Mesothelioma
Thrombus formation in the LV tends to occur in regions of __________ __________ or ______________ ______________ _______________ _______________.
- Blood stasis
- low velocity blood flow
Thrombus formation also often accompanies a LV __________________.
How can Doppler help with LV thrombus?
ID flow presence
List 3 techniques that help ID thrombus: (3)
- 1. TEE
- 2. contrast angio
- 3. radionuclide
Which type of thrombus has a higher embolic potential?
LA thrombus are associated with: (3)
- 1. LAE
- 2. MV disease
- 3. A-fib
The highest incidence of LA thrombus is in patients with _____________________ & _________________.
Rheumatic MS & Afib
Formation of thrombus in the Rt side of heart is rare: T/F
What should the sonographer be thinking when you see Rt heart thrombus?
Fatty deposit in intima
A patent foramen ovale is present in ________ to ________ % of patients.
How can PFO best be evaluated?
TEE - probe inserted into esophagus
IAS aneurysm is a transient ___________________ of fossa ovalis region > ________ mm in the absence of chronic increase of LA or RA __________________.
Spontaneous contrast is:
In the LA there is stasis blood flow creating a "cloud smoke" appearance.