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CT and MR Imaging of Primary Cardiac Malignancies¹

¹ From the Department of Diagnostic Radiology, Mayo Clinic, 200 First St, SW, Rochester, MN 55905. Recipient of a Certificate of Merit award and an Excellence in Design award for a scientific exhibit at the 1998 RSNA scientific assembly. Received February 5, 1999; revision requested March 11 and final revision received March 31; accepted April 1. Address reprint requests to P.A.A.

View larger version (165K): [in a new window]   Figure 1a.   Angiosarcoma in a 79-year-old man. (a) T1-weighted MR image shows a heterogeneous mass (large arrow) involving the right atrial free wall and interatrial septum with extension into the left atrium. There is a loculated pericardial effusion adjacent to the right atrial free wall (small arrow) and pericardial thickening posteriorly (arrowhead). (b) Photograph of a surgical specimen shows intraluminal, polypoid, hemorrhagic tumor nodules (arrow). Atrial wall trabeculae are seen in the lower right portion of the specimen (arrowhead). Scale is in centimeters.

View larger version (132K): [in a new window]   Figure 1b.   Angiosarcoma in a 79-year-old man. (a) T1-weighted MR image shows a heterogeneous mass (large arrow) involving the right atrial free wall and interatrial septum with extension into the left atrium. There is a loculated pericardial effusion adjacent to the right atrial free wall (small arrow) and pericardial thickening posteriorly (arrowhead). (b) Photograph of a surgical specimen shows intraluminal, polypoid, hemorrhagic tumor nodules (arrow). Atrial wall trabeculae are seen in the lower right portion of the specimen (arrowhead). Scale is in centimeters.

View larger version (175K): [in a new window]   Figure 2a.   Undifferentiated sarcoma in a 36-year-old man. Axial (a) and sagittal (b) T1-weighted MR images show a broad-based, lobulated mass arising from the left lateral wall of the left atrium (arrow). The mass is isointense relative to myocardium.

View larger version (177K): [in a new window]   Figure 2b.   Undifferentiated sarcoma in a 36-year-old man. Axial (a) and sagittal (b) T1-weighted MR images show a broad-based, lobulated mass arising from the left lateral wall of the left atrium (arrow). The mass is isointense relative to myocardium.

View larger version (111K): [in a new window]   Figure 3.    Undifferentiated sarcoma in a 42-year-old man. Electron beam CT scan shows irregular thickening of the interventricular septum (black arrow) and pericardial effusion (white arrow).

View larger version (101K): [in a new window]   Figure 4a.   Rhabdomyosarcoma in a 22-year-old woman. (a) Contrast material-enhanced CT scan of the chest shows a large, homogeneous soft-tissue mass in the left atrium (black arrow) with extension through the interatrial septum (white arrow) into the right atrium (arrowhead). (b) Axial T1-weighted spin-echo MR image obtained 6 months later after tumor debulking shows recurrent tumor along the interatrial septum (arrow) and in the pericardial space (arrowhead). (c) Axial T1-weighted spin-echo MR image obtained inferior to b shows a new site of intrapericardial tumor implantation along the anterolateral right ventricular free wall (arrowhead). (d) Photograph of a specimen obtained at initial tumor debulking surgery shows a fleshy tumor with cystic degeneration (arrow). Remnants of myocardium can be seen at the periphery of the mass (arrowhead). Scale is in centimeters.

View larger version (122K): [in a new window]   Figure 4b.   Rhabdomyosarcoma in a 22-year-old woman. (a) Contrast material-enhanced CT scan of the chest shows a large, homogeneous soft-tissue mass in the left atrium (black arrow) with extension through the interatrial septum (white arrow) into the right atrium (arrowhead). (b) Axial T1-weighted spin-echo MR image obtained 6 months later after tumor debulking shows recurrent tumor along the interatrial septum (arrow) and in the pericardial space (arrowhead). (c) Axial T1-weighted spin-echo MR image obtained inferior to b shows a new site of intrapericardial tumor implantation along the anterolateral right ventricular free wall (arrowhead). (d) Photograph of a specimen obtained at initial tumor debulking surgery shows a fleshy tumor with cystic degeneration (arrow). Remnants of myocardium can be seen at the periphery of the mass (arrowhead). Scale is in centimeters.

View larger version (136K): [in a new window]   Figure 4c.   Rhabdomyosarcoma in a 22-year-old woman. (a) Contrast material-enhanced CT scan of the chest shows a large, homogeneous soft-tissue mass in the left atrium (black arrow) with extension through the interatrial septum (white arrow) into the right atrium (arrowhead). (b) Axial T1-weighted spin-echo MR image obtained 6 months later after tumor debulking shows recurrent tumor along the interatrial septum (arrow) and in the pericardial space (arrowhead). (c) Axial T1-weighted spin-echo MR image obtained inferior to b shows a new site of intrapericardial tumor implantation along the anterolateral right ventricular free wall (arrowhead). (d) Photograph of a specimen obtained at initial tumor debulking surgery shows a fleshy tumor with cystic degeneration (arrow). Remnants of myocardium can be seen at the periphery of the mass (arrowhead). Scale is in centimeters.

View larger version (90K): [in a new window]   Figure 4d.   Rhabdomyosarcoma in a 22-year-old woman. (a) Contrast material-enhanced CT scan of the chest shows a large, homogeneous soft-tissue mass in the left atrium (black arrow) with extension through the interatrial septum (white arrow) into the right atrium (arrowhead). (b) Axial T1-weighted spin-echo MR image obtained 6 months later after tumor debulking shows recurrent tumor along the interatrial septum (arrow) and in the pericardial space (arrowhead). (c) Axial T1-weighted spin-echo MR image obtained inferior to b shows a new site of intrapericardial tumor implantation along the anterolateral right ventricular free wall (arrowhead). (d) Photograph of a specimen obtained at initial tumor debulking surgery shows a fleshy tumor with cystic degeneration (arrow). Remnants of myocardium can be seen at the periphery of the mass (arrowhead). Scale is in centimeters.

View larger version (164K): [in a new window]   Figure 5a.   Left ventricular osteosarcoma in a 69-year-old man. (a) Unenhanced CT scan of the chest shows dense calcification (arrow), thought to represent chronic calcification of the posterior medial papillary muscle. (b) On an unenhanced electron beam CT scan obtained 6 years later, the left ventricular calcifications have increased markedly (arrow). (c) Contrast-enhanced CT scan reveals a large, low-attenuation mass occupying the left ventricle (arrowhead). (d) Photograph of an autopsy specimen shows pericardial rind and extensive mural involvement from primary osteogenic sarcoma. Foci of calcification are also seen (arrows). Scale is in centimeters.

View larger version (135K): [in a new window]   Figure 5b.   Left ventricular osteosarcoma in a 69-year-old man. (a) Unenhanced CT scan of the chest shows dense calcification (arrow), thought to represent chronic calcification of the posterior medial papillary muscle. (b) On an unenhanced electron beam CT scan obtained 6 years later, the left ventricular calcifications have increased markedly (arrow). (c) Contrast-enhanced CT scan reveals a large, low-attenuation mass occupying the left ventricle (arrowhead). (d) Photograph of an autopsy specimen shows pericardial rind and extensive mural involvement from primary osteogenic sarcoma. Foci of calcification are also seen (arrows). Scale is in centimeters.

View larger version (167K): [in a new window]   Figure 5c.   Left ventricular osteosarcoma in a 69-year-old man. (a) Unenhanced CT scan of the chest shows dense calcification (arrow), thought to represent chronic calcification of the posterior medial papillary muscle. (b) On an unenhanced electron beam CT scan obtained 6 years later, the left ventricular calcifications have increased markedly (arrow). (c) Contrast-enhanced CT scan reveals a large, low-attenuation mass occupying the left ventricle (arrowhead). (d) Photograph of an autopsy specimen shows pericardial rind and extensive mural involvement from primary osteogenic sarcoma. Foci of calcification are also seen (arrows). Scale is in centimeters.

View larger version (134K): [in a new window]   Figure 5d.   Left ventricular osteosarcoma in a 69-year-old man. (a) Unenhanced CT scan of the chest shows dense calcification (arrow), thought to represent chronic calcification of the posterior medial papillary muscle. (b) On an unenhanced electron beam CT scan obtained 6 years later, the left ventricular calcifications have increased markedly (arrow). (c) Contrast-enhanced CT scan reveals a large, low-attenuation mass occupying the left ventricle (arrowhead). (d) Photograph of an autopsy specimen shows pericardial rind and extensive mural involvement from primary osteogenic sarcoma. Foci of calcification are also seen (arrows). Scale is in centimeters.

View larger version (127K): [in a new window]   Figure 6.   Leiomyosarcoma in a 63-year-old woman. Contrast-enhanced chest CT scan shows a low-attenuation lesion in the left atrium (arrow).

View larger version (127K): [in a new window]   Figure 7a.   Fibrosarcoma in a 43-year-old man. (a, b) Contrast-enhanced electron beam CT scans of the chest show a low-attenuation soft-tissue mass filling the right atrium (straight arrow in a, large arrow in b) and the posterior inferior left atrium (curved arrow in a, small arrow in b), as well as abnormal soft tissue in the right ventricle (arrowhead in a). (c) Oblique sagittal CT reconstruction shows a large soft-tissue mass in the left atrium (curved white arrow), inferior left ventricle (solid straight white arrow), and right ventricle (open arrow). Contrast material is seen in the residual left ventricular lumen (straight black arrow), residual left atrial chamber (curved black arrow), and ascending aorta (arrowhead). (d, e) On axial (d) and coronal (e) T1-weighted MR images obtained 1 year later after chemotherapy, the mass (arrow) appears slightly smaller and is isointense relative to myocardium.

View larger version (128K): [in a new window]   Figure 7b.   Fibrosarcoma in a 43-year-old man. (a, b) Contrast-enhanced electron beam CT scans of the chest show a low-attenuation soft-tissue mass filling the right atrium (straight arrow in a, large arrow in b) and the posterior inferior left atrium (curved arrow in a, small arrow in b), as well as abnormal soft tissue in the right ventricle (arrowhead in a). (c) Oblique sagittal CT reconstruction shows a large soft-tissue mass in the left atrium (curved white arrow), inferior left ventricle (solid straight white arrow), and right ventricle (open arrow). Contrast material is seen in the residual left ventricular lumen (straight black arrow), residual left atrial chamber (curved black arrow), and ascending aorta (arrowhead). (d, e) On axial (d) and coronal (e) T1-weighted MR images obtained 1 year later after chemotherapy, the mass (arrow) appears slightly smaller and is isointense relative to myocardium.

View larger version (123K): [in a new window]   Figure 7c.   Fibrosarcoma in a 43-year-old man. (a, b) Contrast-enhanced electron beam CT scans of the chest show a low-attenuation soft-tissue mass filling the right atrium (straight arrow in a, large arrow in b) and the posterior inferior left atrium (curved arrow in a, small arrow in b), as well as abnormal soft tissue in the right ventricle (arrowhead in a). (c) Oblique sagittal CT reconstruction shows a large soft-tissue mass in the left atrium (curved white arrow), inferior left ventricle (solid straight white arrow), and right ventricle (open arrow). Contrast material is seen in the residual left ventricular lumen (straight black arrow), residual left atrial chamber (curved black arrow), and ascending aorta (arrowhead). (d, e) On axial (d) and coronal (e) T1-weighted MR images obtained 1 year later after chemotherapy, the mass (arrow) appears slightly smaller and is isointense relative to myocardium.

View larger version (133K): [in a new window]   Figure 7d.   Fibrosarcoma in a 43-year-old man. (a, b) Contrast-enhanced electron beam CT scans of the chest show a low-attenuation soft-tissue mass filling the right atrium (straight arrow in a, large arrow in b) and the posterior inferior left atrium (curved arrow in a, small arrow in b), as well as abnormal soft tissue in the right ventricle (arrowhead in a). (c) Oblique sagittal CT reconstruction shows a large soft-tissue mass in the left atrium (curved white arrow), inferior left ventricle (solid straight white arrow), and right ventricle (open arrow). Contrast material is seen in the residual left ventricular lumen (straight black arrow), residual left atrial chamber (curved black arrow), and ascending aorta (arrowhead). (d, e) On axial (d) and coronal (e) T1-weighted MR images obtained 1 year later after chemotherapy, the mass (arrow) appears slightly smaller and is isointense relative to myocardium.

View larger version (167K): [in a new window]   Figure 7e.   Fibrosarcoma in a 43-year-old man. (a, b) Contrast-enhanced electron beam CT scans of the chest show a low-attenuation soft-tissue mass filling the right atrium (straight arrow in a, large arrow in b) and the posterior inferior left atrium (curved arrow in a, small arrow in b), as well as abnormal soft tissue in the right ventricle (arrowhead in a). (c) Oblique sagittal CT reconstruction shows a large soft-tissue mass in the left atrium (curved white arrow), inferior left ventricle (solid straight white arrow), and right ventricle (open arrow). Contrast material is seen in the residual left ventricular lumen (straight black arrow), residual left atrial chamber (curved black arrow), and ascending aorta (arrowhead). (d, e) On axial (d) and coronal (e) T1-weighted MR images obtained 1 year later after chemotherapy, the mass (arrow) appears slightly smaller and is isointense relative to myocardium.

View larger version (130K): [in a new window]   Figure 8.   Recurrent liposarcoma in a 41-year-old man. Contrast-enhanced electron beam CT scan shows a broad-based soft-tissue mass arising from the posterior wall of the left atrium (arrow). A mitral valve prosthesis from a previous resection is also seen (arrowhead).

View larger version (129K): [in a new window]   Figure 9.   Primary cardiac lymphoma in a 75-year-old man. Contrast-enhanced CT scan of the chest shows a low-attenuation mass in the superior right atrium (black arrow) and a large pericardial effusion (white arrows). Pericardial biopsy revealed follicular mixed type B-cell lymphoma.

View larger version (111K): [in a new window]   Figure 10a.   Primary cardiac lymphoma in a 65-year-old man. (a) Contrast-enhanced CT scan shows a large left ventricular mass (arrow). (b) Photograph of an autopsy specimen shows cardiac lymphoma in the left ventricle (arrow), which is partially necrotic and has intramural and intraluminal tumor growth.

View larger version (110K): [in a new window]   Figure 10b.   Primary cardiac lymphoma in a 65-year-old man. (a) Contrast-enhanced CT scan shows a large left ventricular mass (arrow). (b) Photograph of an autopsy specimen shows cardiac lymphoma in the left ventricle (arrow), which is partially necrotic and has intramural and intraluminal tumor growth.