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Primary Cardiac and Pericardial Neoplasms: Radiologic-Pathologic Correlation¹

¹ From the Department of Radiology, National Naval Medical Center, Bethesda, Md (M.L.G.); the Departments of Radiologic Pathology (M.L.R., J.R.G.) and Cardiovascular Pathology (A.P.B.), Armed Forces Institute of Pathology, Bldg 54, Rm M-121, 14th and Alaska Sts, NW, Washington, DC 20306-6000; and the Department of Radiology, Georgetown University Hospital, Washington, DC (C.E.G.). Received March 28, 2000; revision requested April 10 and received April 24; accepted April 24. Address correspondence to M.L.R. (e-mail: rosado@afip.osd.mil).

View larger version (188K): [in a new window]   Figure 1a.   Cardiac myxoma, microscopic features. (a) Low-power photomicrograph (original magnification, x15; hematoxylineosin [H-E] stain) demonstrates a myxomatous stroma containing abundant hemosiderin (dark, granular material most prominent in the upper portion of the photomicrograph). (b) Low-power photomicrograph (original magnification, x75; H-E stain) shows a focus of calcification (central dark staining area) within a myxomatous matrix. (c) High-power photomicrograph (original magnification, x300; periodic-acid Schiff stain) shows nests of myxoma cells (curved arrows) and glandular structures (arrowheads) amid a myxomatous matrix. The glandular differentiation is evidenced by circular lumina and dark red material within the cell cytoplasm (straight arrows).

View larger version (201K): [in a new window]   Figure 1b.   Cardiac myxoma, microscopic features. (a) Low-power photomicrograph (original magnification, x15; hematoxylineosin [H-E] stain) demonstrates a myxomatous stroma containing abundant hemosiderin (dark, granular material most prominent in the upper portion of the photomicrograph). (b) Low-power photomicrograph (original magnification, x75; H-E stain) shows a focus of calcification (central dark staining area) within a myxomatous matrix. (c) High-power photomicrograph (original magnification, x300; periodic-acid Schiff stain) shows nests of myxoma cells (curved arrows) and glandular structures (arrowheads) amid a myxomatous matrix. The glandular differentiation is evidenced by circular lumina and dark red material within the cell cytoplasm (straight arrows).

View larger version (176K): [in a new window]   Figure 1c.   Cardiac myxoma, microscopic features. (a) Low-power photomicrograph (original magnification, x15; hematoxylineosin [H-E] stain) demonstrates a myxomatous stroma containing abundant hemosiderin (dark, granular material most prominent in the upper portion of the photomicrograph). (b) Low-power photomicrograph (original magnification, x75; H-E stain) shows a focus of calcification (central dark staining area) within a myxomatous matrix. (c) High-power photomicrograph (original magnification, x300; periodic-acid Schiff stain) shows nests of myxoma cells (curved arrows) and glandular structures (arrowheads) amid a myxomatous matrix. The glandular differentiation is evidenced by circular lumina and dark red material within the cell cytoplasm (straight arrows).

View larger version (131K): [in a new window]   Figure 2.   Cardiac myxoma, pathologic features. (2) Photograph demonstrates a firm, round lobular mass with a variegated surface.

View larger version (171K): [in a new window]   Figure 3.   Photograph of a left atrial myxoma demonstrates a sessile, multilobular, gelatinous mass. A portion of the interatrial septum (arrow) was excised en block with the tumor.

View larger version (109K): [in a new window]   Figure 4.   Photograph of a left atrial myxoma demonstrates an elongated, focally hemorrhagic mass with an irregular surface.

View larger version (141K): [in a new window]   Figure 5.   Left atrial myxoma in a 41-year-old woman with dyspnea and cough. Posteroanterior chest radiograph shows a prominent left atrial appendage (arrow), pulmonary vascular redistribution, and prominent interstitial markings.

View larger version (143K): [in a new window]   Figure 6a.   Right atrial myxoma in an asymptomatic 55-year-old woman with a heart murmur. (a) Posteroanterior chest radiograph demonstrates dense, ovoid, intracardiac calcification (arrows) and borderline cardiac enlargement. (b) Radiograph of the excised specimen demonstrates multifocal, coarse, flocculent tumoral calcification. The densely calcified focus (*) likely represents the calcification seen on radiographs. (c) Photograph of a cut section of the resected specimen shows calcification (*) and hemorrhage (arrows) within the tumor.

View larger version (106K): [in a new window]   Figure 6b.   Right atrial myxoma in an asymptomatic 55-year-old woman with a heart murmur. (a) Posteroanterior chest radiograph demonstrates dense, ovoid, intracardiac calcification (arrows) and borderline cardiac enlargement. (b) Radiograph of the excised specimen demonstrates multifocal, coarse, flocculent tumoral calcification. The densely calcified focus (*) likely represents the calcification seen on radiographs. (c) Photograph of a cut section of the resected specimen shows calcification (*) and hemorrhage (arrows) within the tumor.

View larger version (121K): [in a new window]   Figure 6c.   Right atrial myxoma in an asymptomatic 55-year-old woman with a heart murmur. (a) Posteroanterior chest radiograph demonstrates dense, ovoid, intracardiac calcification (arrows) and borderline cardiac enlargement. (b) Radiograph of the excised specimen demonstrates multifocal, coarse, flocculent tumoral calcification. The densely calcified focus (*) likely represents the calcification seen on radiographs. (c) Photograph of a cut section of the resected specimen shows calcification (*) and hemorrhage (arrows) within the tumor.

View larger version (123K): [in a new window]   Figure 7a.   Left atrial myxoma in a 48-year-old man with a 2-year history of intermittent fever. (a) Long axis transesophageal echocardiogram demonstrates a lobular and papillary, heterogeneous, echogenic left atrial mass. (b) Photograph shows the variegated gelatinous mass with multiple excrescences that was excised at surgery.

View larger version (117K): [in a new window]   Figure 7b.   Left atrial myxoma in a 48-year-old man with a 2-year history of intermittent fever. (a) Long axis transesophageal echocardiogram demonstrates a lobular and papillary, heterogeneous, echogenic left atrial mass. (b) Photograph shows the variegated gelatinous mass with multiple excrescences that was excised at surgery.

View larger version (126K): [in a new window]   Figure 8a.   Left atrial myxoma in a 61-year-old woman with progressively worsening dyspnea. (a) Non-contrast-enhanced chest CT scan (mediastinal window) shows an ovoid left atrial mass that is hypoattenuating with respect to the surrounding blood. (b) Contrast-enhanced chest CT scan (mediastinal window) shows heterogeneous enhancement of the myxoma, which is attached to the interatrial septum. The contrast material-opacified blood outlines the margins of the lobular mass. Note the large bilateral pleural effusions and bibasilar atelectasis.

View larger version (126K): [in a new window]   Figure 8b.   Left atrial myxoma in a 61-year-old woman with progressively worsening dyspnea. (a) Non-contrast-enhanced chest CT scan (mediastinal window) shows an ovoid left atrial mass that is hypoattenuating with respect to the surrounding blood. (b) Contrast-enhanced chest CT scan (mediastinal window) shows heterogeneous enhancement of the myxoma, which is attached to the interatrial septum. The contrast material-opacified blood outlines the margins of the lobular mass. Note the large bilateral pleural effusions and bibasilar atelectasis.

View larger version (112K): [in a new window]   Figure 9a.   Right atrial myxoma in a 51-year-old woman with abdominal complaints. (a) Contrast-enhanced chest CT scan (mediastinal window) shows a lobular heterogeneous right atrial mass with foci of internal calcification and resultant atrial enlargement. (b) Photograph of the cut specimen shows a lobular, heterogeneous, ovoid mass.

View larger version (138K): [in a new window]   Figure 9b.   Right atrial myxoma in a 51-year-old woman with abdominal complaints. (a) Contrast-enhanced chest CT scan (mediastinal window) shows a lobular heterogeneous right atrial mass with foci of internal calcification and resultant atrial enlargement. (b) Photograph of the cut specimen shows a lobular, heterogeneous, ovoid mass.

View larger version (134K): [in a new window]   Figure 10a.   Left atrial myxoma in a 71-year-old man with angina and transient ischemic attacks. (a) Axial proton density-weighted ([echo time msec/repetition time msec] 2,769/20) MR image shows a tumor with a heterogeneous appearance: peripheral high signal intensity and central low signal intensity. The high signal intensity likely represents the myxomatous components. (b) Axial cine GRE (50/12) MR image better demonstrates the point of attachment of the tumor. Note the complete loss of signal intensity in the tumor, a finding that may represent a high iron content.

View larger version (106K): [in a new window]   Figure 10b.   Left atrial myxoma in a 71-year-old man with angina and transient ischemic attacks. (a) Axial proton density-weighted ([echo time msec/repetition time msec] 2,769/20) MR image shows a tumor with a heterogeneous appearance: peripheral high signal intensity and central low signal intensity. The high signal intensity likely represents the myxomatous components. (b) Axial cine GRE (50/12) MR image better demonstrates the point of attachment of the tumor. Note the complete loss of signal intensity in the tumor, a finding that may represent a high iron content.

View larger version (121K): [in a new window]   Figure 11a.   Right atrial myxoma in a 47-year-old woman with prominent neck vein pulsations, fatigue, and headache. (a) Coronal T1-weighted (869/20) MR image demonstrates a spherical heterogeneous mass attached to the lateral wall of the right atrium. (b) Axial T1-weighted (722/20) gadolinium-enhanced MR image demonstrates heterogeneous central foci of enhancement of the myxoma.

View larger version (131K): [in a new window]   Figure 11b.   Right atrial myxoma in a 47-year-old woman with prominent neck vein pulsations, fatigue, and headache. (a) Coronal T1-weighted (869/20) MR image demonstrates a spherical heterogeneous mass attached to the lateral wall of the right atrium. (b) Axial T1-weighted (722/20) gadolinium-enhanced MR image demonstrates heterogeneous central foci of enhancement of the myxoma.

View larger version (88K): [in a new window]   Figure 12.   Left atrial myxoma in a 52-year-old man with dyspnea on exertion. Axial cine GRE (75/12) MR images, obtained during systole and diastole, demonstrate the point of attachment (arrowheads) to the interatrial septum and the tumor prolapse across the mitral valve (arrow) during diastole. The tumor has an elongated morphology and low signal intensity.

View larger version (154K): [in a new window]   Figure 13a.   Papillary fibroelastoma in a 69-year-old man with chronic atrial fibrillation. (a) Transthoracic four-chamber echocardiogram shows a rounded echogenic mass (arrow) attached to the apex of the left ventricle (LV). LA = left atrium, RA = right atrium, LV = left ventricle. (b) Axial, cine GRE (66/5) MR image demonstrates a 1-cm mass at the apex of the left ventricle (arrowhead). (c) Photograph of the excised specimen shows a gelatinous, multilobular, papillary mass.

View larger version (135K): [in a new window]   Figure 13b.   Papillary fibroelastoma in a 69-year-old man with chronic atrial fibrillation. (a) Transthoracic four-chamber echocardiogram shows a rounded echogenic mass (arrow) attached to the apex of the left ventricle (LV). LA = left atrium, RA = right atrium, LV = left ventricle. (b) Axial, cine GRE (66/5) MR image demonstrates a 1-cm mass at the apex of the left ventricle (arrowhead). (c) Photograph of the excised specimen shows a gelatinous, multilobular, papillary mass.

View larger version (106K): [in a new window]   Figure 13c.   Papillary fibroelastoma in a 69-year-old man with chronic atrial fibrillation. (a) Transthoracic four-chamber echocardiogram shows a rounded echogenic mass (arrow) attached to the apex of the left ventricle (LV). LA = left atrium, RA = right atrium, LV = left ventricle. (b) Axial, cine GRE (66/5) MR image demonstrates a 1-cm mass at the apex of the left ventricle (arrowhead). (c) Photograph of the excised specimen shows a gelatinous, multilobular, papillary mass.

View larger version (195K): [in a new window]   Figure 14.   Rhabdomyoma, microscopic features. High-power photomicrograph (original magnification, x300; H-E stain) demonstrates typical vacuolated cells of rhabdomyoma. Cytoplasmic streaming is a typical artifact that results in "spider cells" (arrows).

View larger version (129K): [in a new window]   Figure 15a.   Rhabdomyoma in a 3-month-old boy with tachycardia. (a) Coronal T1-weighted (370/25) MR image shows diffuse heterogeneous nodular thickening of the left ventricular myocardium and interventricular septum (arrows). (b) Photograph of the cut autopsy specimen of the heart shows multiple, firm, white nodules distributed throughout the left ventricular myocardium (arrows).

View larger version (115K): [in a new window]   Figure 15b.   Rhabdomyoma in a 3-month-old boy with tachycardia. (a) Coronal T1-weighted (370/25) MR image shows diffuse heterogeneous nodular thickening of the left ventricular myocardium and interventricular septum (arrows). (b) Photograph of the cut autopsy specimen of the heart shows multiple, firm, white nodules distributed throughout the left ventricular myocardium (arrows).

View larger version (193K): [in a new window]   Figure 16.   Fibroma, microscopic features. High-power photomicrograph (original magnification, x150; H-E stain) demonstrates dense collagen bundles in a largely acellular fibroma.

View larger version (136K): [in a new window]   Figure 17a.   Cardiac fibroma in a newborn girl in whom anterior myocardial thickening had been noted at prenatal US. (a, b) Axial T1- (354/25) (a) and sagittal T1-weighted (401/25) (b) MR images demonstrate a large homogeneous mural mass of the anterior wall of the right ventricle that nearly obliterates the right ventricular cavity. (c) Intraoperative photograph shows the large right ventricular mural mass (m).

View larger version (155K): [in a new window]   Figure 17b.   Cardiac fibroma in a newborn girl in whom anterior myocardial thickening had been noted at prenatal US. (a, b) Axial T1- (354/25) (a) and sagittal T1-weighted (401/25) (b) MR images demonstrate a large homogeneous mural mass of the anterior wall of the right ventricle that nearly obliterates the right ventricular cavity. (c) Intraoperative photograph shows the large right ventricular mural mass (m).

View larger version (125K): [in a new window]   Figure 17c.   Cardiac fibroma in a newborn girl in whom anterior myocardial thickening had been noted at prenatal US. (a, b) Axial T1- (354/25) (a) and sagittal T1-weighted (401/25) (b) MR images demonstrate a large homogeneous mural mass of the anterior wall of the right ventricle that nearly obliterates the right ventricular cavity. (c) Intraoperative photograph shows the large right ventricular mural mass (m).

View larger version (189K): [in a new window]   Figure 18.   Hemangioma, microscopic features. High-power photomicrograph (original magnification, x125; H-E stain) shows characteristic dilated vascular channels (curved arrows) interspersed among myocardial cells. There are scattered fat cells within the interstitium (straight arrows).

View larger version (118K): [in a new window]   Figure 19a.   Cardiac hemangioma in a 24-year-old pregnant woman with Marfan syndrome and mild aortic root dilatation, who was found to have a left ventricular mass at surveillance echocardiography. (a) Axial T1-weighted (631/11) MR image demonstrates a lobular, pedunculated, intracavitary left ventricular mass (arrow) arising from the posterior papillary muscle (arrowhead). (b) Photograph shows the tan, bosselated mass that was excised at surgery.

View larger version (117K): [in a new window]   Figure 19b.   Cardiac hemangioma in a 24-year-old pregnant woman with Marfan syndrome and mild aortic root dilatation, who was found to have a left ventricular mass at surveillance echocardiography. (a) Axial T1-weighted (631/11) MR image demonstrates a lobular, pedunculated, intracavitary left ventricular mass (arrow) arising from the posterior papillary muscle (arrowhead). (b) Photograph shows the tan, bosselated mass that was excised at surgery.

View larger version (134K): [in a new window]   Figure 20a.   Intracardiac lipoma in a 45-year-old woman with palpitations. (a, b) Axial (a) and coronal (b) proton density-weighted (1,091/20) MR images demonstrate a smooth, round, intracavitary right atrial mass with a signal intensity characteristic of fat. (c) Photograph of the specimen demonstrates a well-circumscribed, spherical, yellow mass that was excised from the right atrium.

View larger version (151K): [in a new window]   Figure 20b.   Intracardiac lipoma in a 45-year-old woman with palpitations. (a, b) Axial (a) and coronal (b) proton density-weighted (1,091/20) MR images demonstrate a smooth, round, intracavitary right atrial mass with a signal intensity characteristic of fat. (c) Photograph of the specimen demonstrates a well-circumscribed, spherical, yellow mass that was excised from the right atrium.

View larger version (83K): [in a new window]   Figure 20c.   Intracardiac lipoma in a 45-year-old woman with palpitations. (a, b) Axial (a) and coronal (b) proton density-weighted (1,091/20) MR images demonstrate a smooth, round, intracavitary right atrial mass with a signal intensity characteristic of fat. (c) Photograph of the specimen demonstrates a well-circumscribed, spherical, yellow mass that was excised from the right atrium.

View larger version (228K): [in a new window]   Figure 21.   Paraganglioma, microscopic features. High-power photomicrograph (original magnification, x300; H-E stain) demonstrates the classic nesting (zellballen) appearance of the paraganglial cells.

View larger version (137K): [in a new window]   Figure 22a.   Cardiac paraganglioma in a 13-year-old boy with a heart murmur and hypertension. (a) Axial T1-weighted (400/20) MR image demonstrates a round, lobular mass of intermediate signal intensity arising from the interatrial septum and protruding into both atria. (b) Axial proton density-weighted (2,000/20) MR image shows an increase in tumor signal intensity. Intraoperative palpation of this paraganglioma resulted in immediate, severe hypertension and tachycardia.

View larger version (134K): [in a new window]   Figure 22b.   Cardiac paraganglioma in a 13-year-old boy with a heart murmur and hypertension. (a) Axial T1-weighted (400/20) MR image demonstrates a round, lobular mass of intermediate signal intensity arising from the interatrial septum and protruding into both atria. (b) Axial proton density-weighted (2,000/20) MR image shows an increase in tumor signal intensity. Intraoperative palpation of this paraganglioma resulted in immediate, severe hypertension and tachycardia.

View larger version (187K): [in a new window]   Figure 23.   Mature teratoma, microscopic features. Low-power photomicrograph (original magnification, x75; Masson trichrome stain) demonstrates neuroretinal (ectodermal) (thin arrow) and glandular (endodermal) (thick arrows) structures. The blue staining material (arrowheads) is connective (mesodermal) tissue.

View larger version (129K): [in a new window]   Figure 24a.   Mature teratoma in a 2-year-old girl with respiratory distress and cardiomegaly. (a, b) Posteroanterior (a) and collimated posteroanterior (b) chest radiographs demonstrate an enlarged cardiac silhouette and a tooth (arrow) that projects over the anterior heart. (c) Axial T1-weighted MR image shows the large, heterogeneous, lobular multicystic pericardial mass.

View larger version (134K): [in a new window]   Figure 24b.   Mature teratoma in a 2-year-old girl with respiratory distress and cardiomegaly. (a, b) Posteroanterior (a) and collimated posteroanterior (b) chest radiographs demonstrate an enlarged cardiac silhouette and a tooth (arrow) that projects over the anterior heart. (c) Axial T1-weighted MR image shows the large, heterogeneous, lobular multicystic pericardial mass.

View larger version (149K): [in a new window]   Figure 24c.   Mature teratoma in a 2-year-old girl with respiratory distress and cardiomegaly. (a, b) Posteroanterior (a) and collimated posteroanterior (b) chest radiographs demonstrate an enlarged cardiac silhouette and a tooth (arrow) that projects over the anterior heart. (c) Axial T1-weighted MR image shows the large, heterogeneous, lobular multicystic pericardial mass.

View larger version (153K): [in a new window]   Figure 25a.   Mature teratoma in a 1-month-old girl with heart failure. (a) Sagittal T1-weighted (560/25) MR image demonstrates a large, heterogeneous anterior pericardial mass that compresses the cardiac chambers and displaces the heart posteriorly. There is a large pericardial effusion (arrow). (b) Photograph of a cut specimen of the tumor shows a firm, white lobular, multilocular cystic mass.

View larger version (81K): [in a new window]   Figure 25b.   Mature teratoma in a 1-month-old girl with heart failure. (a) Sagittal T1-weighted (560/25) MR image demonstrates a large, heterogeneous anterior pericardial mass that compresses the cardiac chambers and displaces the heart posteriorly. There is a large pericardial effusion (arrow). (b) Photograph of a cut specimen of the tumor shows a firm, white lobular, multilocular cystic mass.

View larger version (181K): [in a new window]   Figure 26.   Angiosarcoma, microscopic features. High-power photomicrograph (original magnification, x450; H-E stain) demonstrates irregular anastomosing vascular channels lined by atypical endothelial cells.

View larger version (116K): [in a new window]   Figure 27a.   Unclassified sarcoma in a 29-year-old man with cough, fever, and weight loss who underwent heart transplantation. (a) Coronal T1-weighted (714/12) MR image shows a large, invasive mass of intermediate signal intensity involving the left side of the heart. (b) Photograph of the excised heart shows the nodular mass invading the left atrial wall and mitral valve.

View larger version (91K): [in a new window]   Figure 27b.   Unclassified sarcoma in a 29-year-old man with cough, fever, and weight loss who underwent heart transplantation. (a) Coronal T1-weighted (714/12) MR image shows a large, invasive mass of intermediate signal intensity involving the left side of the heart. (b) Photograph of the excised heart shows the nodular mass invading the left atrial wall and mitral valve.

View larger version (121K): [in a new window]   Figure 28a.   Angiosarcoma in a 28-year-old woman who presented with mitral valve obstruction. (a) Axial contrast-enhanced chest CT scan (mediastinal window) shows a large nodular, homogeneous, soft-tissue mass that invades the right atrium and encases the heart. (b) Coronal T2-weighted (3,780/57) MR image demonstrates extensive circumferential cardiac involvement by the nodular, heterogeneous, hyperintense tumor, which invades the right atrium and encases the heart.

View larger version (135K): [in a new window]   Figure 28b.   Angiosarcoma in a 28-year-old woman who presented with mitral valve obstruction. (a) Axial contrast-enhanced chest CT scan (mediastinal window) shows a large nodular, homogeneous, soft-tissue mass that invades the right atrium and encases the heart. (b) Coronal T2-weighted (3,780/57) MR image demonstrates extensive circumferential cardiac involvement by the nodular, heterogeneous, hyperintense tumor, which invades the right atrium and encases the heart.

View larger version (210K): [in a new window]   Figure 29.   Lymphoma, microscopic features. High-power photomicrograph (original magnification, x300; H-E stain) demonstrates lymphoma cells (dark blue round cells) surrounding and infiltrating residual myocytes (arrow).

View larger version (119K): [in a new window]   Figure 30a.   Primary cardiac lymphoma in a 75-year-old woman with progressive dyspnea, superior vena cava syndrome, and atrial fibrillation. (a) Coronal T1-weighted (571/12) MR image shows vena caval invasion (arrow) by a mass. (b) Superior vena cavogram demonstrates the large intraluminal tumor that obstructs the vena cava. Note the collateral blood flow through the azygos and hemiazygos veins. (c) Photograph of the specimen of the heart obtained at autopsy shows a firm, white, multinodular right atrial tumor with plaquelike pericardial infiltration (arrow) and obstruction of the superior vena cava (*).

View larger version (125K): [in a new window]   Figure 30b.   Primary cardiac lymphoma in a 75-year-old woman with progressive dyspnea, superior vena cava syndrome, and atrial fibrillation. (a) Coronal T1-weighted (571/12) MR image shows vena caval invasion (arrow) by a mass. (b) Superior vena cavogram demonstrates the large intraluminal tumor that obstructs the vena cava. Note the collateral blood flow through the azygos and hemiazygos veins. (c) Photograph of the specimen of the heart obtained at autopsy shows a firm, white, multinodular right atrial tumor with plaquelike pericardial infiltration (arrow) and obstruction of the superior vena cava (*).

View larger version (133K): [in a new window]   Figure 30c.   Primary cardiac lymphoma in a 75-year-old woman with progressive dyspnea, superior vena cava syndrome, and atrial fibrillation. (a) Coronal T1-weighted (571/12) MR image shows vena caval invasion (arrow) by a mass. (b) Superior vena cavogram demonstrates the large intraluminal tumor that obstructs the vena cava. Note the collateral blood flow through the azygos and hemiazygos veins. (c) Photograph of the specimen of the heart obtained at autopsy shows a firm, white, multinodular right atrial tumor with plaquelike pericardial infiltration (arrow) and obstruction of the superior vena cava (*).

View larger version (189K): [in a new window]   Figure 31.   Mesothelioma, microscopic features. High-power photomicrograph (original magnification, x400; H-E stain) demonstrates tubulopapillary structures (arrow) characteristic of epithelial mesothelioma.

View larger version (117K): [in a new window]   Figure 32a.   Pericardial mesothelioma in a 36-year-old woman with fatigue, malaise, and dyspnea. (a) Axial contrast-enhanced chest CT scan (mediastinal window) demonstrates a lobular, heterogeneous left pericardial mass with a large pericardial and bilateral pleural effusions. Note the large areas of low attenuation (arrow), likely representing necrosis, within the tumor. (b) Photograph of the cut specimen of the heart obtained at autopsy shows a diffuse nodular pericardial mass that encases the heart. Scale is in centimeters.

View larger version (141K): [in a new window]   Figure 32b.   Pericardial mesothelioma in a 36-year-old woman with fatigue, malaise, and dyspnea. (a) Axial contrast-enhanced chest CT scan (mediastinal window) demonstrates a lobular, heterogeneous left pericardial mass with a large pericardial and bilateral pleural effusions. Note the large areas of low attenuation (arrow), likely representing necrosis, within the tumor. (b) Photograph of the cut specimen of the heart obtained at autopsy shows a diffuse nodular pericardial mass that encases the heart. Scale is in centimeters.

View larger version (101K): [in a new window]   Figure 33a.   Left ventricular thrombus in a 40-year-old woman who suffered an anterior wall myocardial infarction. The thrombus disappeared following anticoagulant therapy. (a) Contrast-enhanced chest CT scan (mediastinal window) shows a soft-tissue mass in a dilated left ventricle. (b) Axial spin-echo T1-weighted (500/30) MR image shows the heterogeneous left ventricular mass. The left ventricle is dilated and the anterior left ventricular wall is thinned secondary to the myocardial infarction.

View larger version (141K): [in a new window]   Figure 33b.   Left ventricular thrombus in a 40-year-old woman who suffered an anterior wall myocardial infarction. The thrombus disappeared following anticoagulant therapy. (a) Contrast-enhanced chest CT scan (mediastinal window) shows a soft-tissue mass in a dilated left ventricle. (b) Axial spin-echo T1-weighted (500/30) MR image shows the heterogeneous left ventricular mass. The left ventricle is dilated and the anterior left ventricular wall is thinned secondary to the myocardial infarction.

View larger version (128K): [in a new window]   Figure 34a.   Well-differentiated cardiac leiomyosarcoma in a 46-year-old man with dyspnea and medullary compression from a metastasis to the base of the skull. (a, b) Posteroanterior (a) and lateral (b) chest radiographs demonstrate left atrial enlargement (arrows), pulmonary vascular redistribution, and pulmonary interstitial edema. Note Kerley B lines of both bases. (c) Axial T1-weighted (480/21) MR image shows an aggressive left atrial mass of intermediate signal intensity that effaces the atrial lumen and extends through the posterior atrial wall and into the pulmonary veins. Note the bilateral pleural effusions.

View larger version (137K): [in a new window]   Figure 34b.   Well-differentiated cardiac leiomyosarcoma in a 46-year-old man with dyspnea and medullary compression from a metastasis to the base of the skull. (a, b) Posteroanterior (a) and lateral (b) chest radiographs demonstrate left atrial enlargement (arrows), pulmonary vascular redistribution, and pulmonary interstitial edema. Note Kerley B lines of both bases. (c) Axial T1-weighted (480/21) MR image shows an aggressive left atrial mass of intermediate signal intensity that effaces the atrial lumen and extends through the posterior atrial wall and into the pulmonary veins. Note the bilateral pleural effusions.

View larger version (118K): [in a new window]   Figure 34c.   Well-differentiated cardiac leiomyosarcoma in a 46-year-old man with dyspnea and medullary compression from a metastasis to the base of the skull. (a, b) Posteroanterior (a) and lateral (b) chest radiographs demonstrate left atrial enlargement (arrows), pulmonary vascular redistribution, and pulmonary interstitial edema. Note Kerley B lines of both bases. (c) Axial T1-weighted (480/21) MR image shows an aggressive left atrial mass of intermediate signal intensity that effaces the atrial lumen and extends through the posterior atrial wall and into the pulmonary veins. Note the bilateral pleural effusions.

View larger version (121K): [in a new window]   Figure 35.   Fatty infiltration of the interatrial septum in a 69-year-old, mildly obese woman with palpitations, dyspnea, and an atrial tachyarrhythmia. Contrast-enhanced chest CT scan (mediastinal window) demonstrates wedge-shaped fatty thickening of the interatrial septum (arrows). Note the extension of fatty tissue into the right atrium (arrowhead).