Echo 530

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Author:
lstaal1
ID:
21981
Filename:
Echo 530
Updated:
2010-06-04 12:44:28
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Module2
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Description:
Cardiac Masses
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  1. A cardiac mass can be defined as:
    Abnormal structure withing or immediately adjacent to heart
  2. Etiology of cardiac masses are:
    1.
    2.
    3.
    4.
    • 1. primary (malignant or benign)
    • 2. secondary mets
    • 3. Thrombus (mass)
    • 4. Vegetations (endocarditis)
  3. Primary benign tumors are MC than primary malignant tumors? T/F
    True. Malignant is very bad news
  4. Myxoma is a common benign tumor occuring _________________ of the time.
    30%
  5. Symptoms of myxomas are: (5)
    • Orthopenia
    • Acute Pulmonary Edema
    • Cough
    • Hemoptysis
    • Palpitations
  6. Explain why BP and murmurs would change with varying patient postions in a patient with a myxoma?
    Tumor moves with gravity
  7. 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
  8. Complications of Myxoma: (6)
    • Embolization
    • Infected myxoma
    • fever
    • weight loss
    • anemia
    • complications assoc MS & MR
  9. What is the Tx for a myxoma?
    immediate surgery
  10. Myxoma's occur in the LA only? T/F
    • False
    • LA 75%
    • LV 4%
    • RA 18%
    • RV 4%
  11. List some ways to differentiate a myxoma from thrombus with respect to:
    1. mobility
    2. borders / surface
    3. how attached or based
    4. appearance
    5. atrial / ventricle dimestions
    6. AV valves
    7. Location
    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
  12. The MC valvular tumor is __________________ and this tumor rarely exceeds _______________ diameter.
    • papilary fibroelastoma
    • 1cm
  13. Lipomas are usually found in _____________________ with a ___________________ appearance due to _____________ ________________.
    • IAS
    • dumbell
    • fatty sparing of FO
  14. Fibromas typically present in childhood? T/F
    True
  15. MC primary tumor found in children is __________________________.
    Rhabdomyoma
  16. MC primary malignant tumor is _____________________?
    Angiosarcoma
  17. Secondary metastatic tumors arise from (5):
    1.
    2.
    3.
    4.
    5.
    • 1. Leukemia
    • 2. Lymphoma
    • 3. Lung Ca
    • 4. Melanoma
    • 5. Breast Ca
  18. 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
  19. List 4 types of Thrombi:
    • 1. Layered
    • 2. Pedunculated
    • 3. Multilobulated
    • 4. Single
  20. What is a missile?
    Foreign body. Example: knife, bullet, nail
  21. List the normal variants of the RV
    • 1. moderator band
    • 2. trabeculations
    • 3. Catheter
    • 4. Pacemaker wire
  22. Name some normal variants of LV
    • 1. False cord
    • 2. Pap muscles
    • 3. Trabeculations
  23. 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
  24. 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
  25. Name benign tumors (5)
    • Myxoma
    • Papillary Fibroelastoma
    • Lipoma
    • Fibroma
    • Rhabdomyoma
  26. Malignant tumors would be: (3)
    • Sarcoma
    • Angiosarcoma
    • Mets
  27. 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
  28. Displacement of heart, compression of cardiac chambers, SVC obstruction, tamponade, constrictive pericarditis, PS or TS may be the result of an _____________________ ____________________.
    Extracardiac tumor
  29. Normal variant of AO valve include? (2)
    • 1. Lambl's Excrescence
    • 2. Nodule of Arantus
  30. The 3 basic types of cardiac masses are:
    • 1. Tumor
    • 2. Thrombus
    • 3. Vegetation
  31. Marantic endocarditis is ______________ ________________ ________________.
    nonbacterial thrombotic endocarditis
  32. Nonprimary cardiac tumors are approx ______________ more common than primary cardiac tumors.
    20X
  33. Nonprimary cardiac tumors can affect the heart by invasion of the __________________, production of __________________ active substances, and have a ________________ effect of treatment on the heart.
    • pericardium
    • biologically
    • toxic
  34. Differential Dx of PE in patient with known malignancy could include: (3)
    • 1. radiation pericarditis
    • 2. idiopathic pericarditis
    • 3. mets
  35. What percentage of cardiac tumors are benign?
    75%
  36. Primary tumors in order of frequency are:
    1.
    2.
    3.
    4.
    5.
    • 1. Myxoma
    • 2. Lipoma
    • 3. Papillary Fibroelastoma
    • 4. Hemangioma
    • 5. Mesothelioma
  37. Thrombus formation in the LV tends to occur in regions of __________ __________ or ______________ ______________ _______________ _______________.
    • Blood stasis
    • low velocity blood flow
  38. Thrombus formation also often accompanies a LV __________________.
    pseudoaneurysm
  39. How can Doppler help with LV thrombus?
    ID flow presence
  40. List 3 techniques that help ID thrombus: (3)
    • 1. TEE
    • 2. contrast angio
    • 3. radionuclide
  41. Which type of thrombus has a higher embolic potential?
    protruding
  42. LA thrombus are associated with: (3)
    1.
    2.
    3.
    • 1. LAE
    • 2. MV disease
    • 3. A-fib
  43. The highest incidence of LA thrombus is in patients with _____________________ & _________________.
    Rheumatic MS & Afib
  44. Formation of thrombus in the Rt side of heart is rare: T/F
    True
  45. What should the sonographer be thinking when you see Rt heart thrombus?
    Mets
  46. Define: Atheroma
    Fatty deposit in intima
  47. A patent foramen ovale is present in ________ to ________ % of patients.
    25-35%
  48. How can PFO best be evaluated?
    TEE - probe inserted into esophagus
  49. IAS aneurysm is a transient ___________________ of fossa ovalis region > ________ mm in the absence of chronic increase of LA or RA __________________.
    • bulging
    • 15
    • pressure
  50. Spontaneous contrast is:
    In the LA there is stasis blood flow creating a "cloud smoke" appearance.

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