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CT and MR Imaging of Benign Primary Cardiac Neoplasms with Echocardiographic Correlation¹

¹ From the Departments of Radiology (P.A.A., P.R.J., J.F.B.), Internal Medicine (Division of Cardiovascular Diseases) (S.L.M.), and Pathology (H.D.T.), Mayo Clinic, 200 First St SW, Rochester, MN 55905. Received February 8, 2000; revision requested March 8 and received March 31; accepted April 5. Address correspondence to P.A.A., Department of Radiology, University of California at San Francisco, 505 Parnassus Ave, San Francisco, California 94143. (e-mail: phil.araoz@radiology.ucsf.edu).

View larger version (135K): [in a new window]   Figure 1a.   Left atrial myxoma in a 60-year-old man. (a) Transverse transesophageal echocardiogram obtained during diastole shows a large, inhomogeneous mass in the left atrium (LA) (white arrow) with focal areas of calcification (black arrow). The mass fills much of the visualized left atrium. The left ventricular outflow track (arrowhead) is seen on the left side of the image. (b) Contrast material-enhanced electron beam CT scan obtained at the level of the aortic root shows the left atrial mass with prominent calcification (arrow). (c) On a contrast-enhanced electron beam CT scan obtained at a slightly lower level, the mass demonstrates a narrow base of attachment to the interatrial septum (arrow). (d) Photograph of the resected specimen shows the myxoma with a narrow pedicle (large arrow). Marked myxoid change, focal hemorrhage (small arrow), and focal calcifications (arrowheads) are also seen.

View larger version (128K): [in a new window]   Figure 1b.   Left atrial myxoma in a 60-year-old man. (a) Transverse transesophageal echocardiogram obtained during diastole shows a large, inhomogeneous mass in the left atrium (LA) (white arrow) with focal areas of calcification (black arrow). The mass fills much of the visualized left atrium. The left ventricular outflow track (arrowhead) is seen on the left side of the image. (b) Contrast material-enhanced electron beam CT scan obtained at the level of the aortic root shows the left atrial mass with prominent calcification (arrow). (c) On a contrast-enhanced electron beam CT scan obtained at a slightly lower level, the mass demonstrates a narrow base of attachment to the interatrial septum (arrow). (d) Photograph of the resected specimen shows the myxoma with a narrow pedicle (large arrow). Marked myxoid change, focal hemorrhage (small arrow), and focal calcifications (arrowheads) are also seen.

View larger version (113K): [in a new window]   Figure 1c.   Left atrial myxoma in a 60-year-old man. (a) Transverse transesophageal echocardiogram obtained during diastole shows a large, inhomogeneous mass in the left atrium (LA) (white arrow) with focal areas of calcification (black arrow). The mass fills much of the visualized left atrium. The left ventricular outflow track (arrowhead) is seen on the left side of the image. (b) Contrast material-enhanced electron beam CT scan obtained at the level of the aortic root shows the left atrial mass with prominent calcification (arrow). (c) On a contrast-enhanced electron beam CT scan obtained at a slightly lower level, the mass demonstrates a narrow base of attachment to the interatrial septum (arrow). (d) Photograph of the resected specimen shows the myxoma with a narrow pedicle (large arrow). Marked myxoid change, focal hemorrhage (small arrow), and focal calcifications (arrowheads) are also seen.

View larger version (112K): [in a new window]   Figure 1d.   Left atrial myxoma in a 60-year-old man. (a) Transverse transesophageal echocardiogram obtained during diastole shows a large, inhomogeneous mass in the left atrium (LA) (white arrow) with focal areas of calcification (black arrow). The mass fills much of the visualized left atrium. The left ventricular outflow track (arrowhead) is seen on the left side of the image. (b) Contrast material-enhanced electron beam CT scan obtained at the level of the aortic root shows the left atrial mass with prominent calcification (arrow). (c) On a contrast-enhanced electron beam CT scan obtained at a slightly lower level, the mass demonstrates a narrow base of attachment to the interatrial septum (arrow). (d) Photograph of the resected specimen shows the myxoma with a narrow pedicle (large arrow). Marked myxoid change, focal hemorrhage (small arrow), and focal calcifications (arrowheads) are also seen.

View larger version (126K): [in a new window]   Figure 2a.   Right ventricular myxoma in a 55-year-old man. (a) Parasternal transthoracic echocardiogram (short-axis view) obtained during systole shows a mass (straight solid arrow) that prolapses from the right ventricle into the main pulmonary artery (open arrow). Rib attenuation casts a shadow over the right side of the image. The tricuspid valve (curved arrow) and aortic root (arrowhead) are also seen. (b, c) Contrast-enhanced electron beam CT scans obtained at the level of the ventricles (b) and main pulmonary artery (c) show the low-attenuation mass in the right ventricle (arrow in b) with extension into the main pulmonary artery (arrow in c). (d) Photograph of the resected specimen shows the homogeneous, elongated myxoma with a pedicle at the base (arrow).

View larger version (118K): [in a new window]   Figure 2b.   Right ventricular myxoma in a 55-year-old man. (a) Parasternal transthoracic echocardiogram (short-axis view) obtained during systole shows a mass (straight solid arrow) that prolapses from the right ventricle into the main pulmonary artery (open arrow). Rib attenuation casts a shadow over the right side of the image. The tricuspid valve (curved arrow) and aortic root (arrowhead) are also seen. (b, c) Contrast-enhanced electron beam CT scans obtained at the level of the ventricles (b) and main pulmonary artery (c) show the low-attenuation mass in the right ventricle (arrow in b) with extension into the main pulmonary artery (arrow in c). (d) Photograph of the resected specimen shows the homogeneous, elongated myxoma with a pedicle at the base (arrow).

View larger version (96K): [in a new window]   Figure 2c.   Right ventricular myxoma in a 55-year-old man. (a) Parasternal transthoracic echocardiogram (short-axis view) obtained during systole shows a mass (straight solid arrow) that prolapses from the right ventricle into the main pulmonary artery (open arrow). Rib attenuation casts a shadow over the right side of the image. The tricuspid valve (curved arrow) and aortic root (arrowhead) are also seen. (b, c) Contrast-enhanced electron beam CT scans obtained at the level of the ventricles (b) and main pulmonary artery (c) show the low-attenuation mass in the right ventricle (arrow in b) with extension into the main pulmonary artery (arrow in c). (d) Photograph of the resected specimen shows the homogeneous, elongated myxoma with a pedicle at the base (arrow).

View larger version (146K): [in a new window]   Figure 2d.   Right ventricular myxoma in a 55-year-old man. (a) Parasternal transthoracic echocardiogram (short-axis view) obtained during systole shows a mass (straight solid arrow) that prolapses from the right ventricle into the main pulmonary artery (open arrow). Rib attenuation casts a shadow over the right side of the image. The tricuspid valve (curved arrow) and aortic root (arrowhead) are also seen. (b, c) Contrast-enhanced electron beam CT scans obtained at the level of the ventricles (b) and main pulmonary artery (c) show the low-attenuation mass in the right ventricle (arrow in b) with extension into the main pulmonary artery (arrow in c). (d) Photograph of the resected specimen shows the homogeneous, elongated myxoma with a pedicle at the base (arrow).

View larger version (130K): [in a new window]   Figure 3a.   Left ventricular myxoma in a 41-year-old man. (a) Transesophageal echocardiogram (four-chamber view) centered on the left ventricle shows a pedunculated mass (arrowhead) with a faintly visible stalk arising from the lateral wall of the left ventricle (arrows). (b, c) Unenhanced (b) and contrast-enhanced (c) T1-weighted MR images demonstrate the small mass attached to the lateral wall of the left ventricle (arrow). The mass shows marked enhancement in c. (d) Photograph of the resected specimen shows the homogeneous, polypoid myxoma with a narrow pedicle (arrow). Scale is in centimeters.

View larger version (113K): [in a new window]   Figure 3b.   Left ventricular myxoma in a 41-year-old man. (a) Transesophageal echocardiogram (four-chamber view) centered on the left ventricle shows a pedunculated mass (arrowhead) with a faintly visible stalk arising from the lateral wall of the left ventricle (arrows). (b, c) Unenhanced (b) and contrast-enhanced (c) T1-weighted MR images demonstrate the small mass attached to the lateral wall of the left ventricle (arrow). The mass shows marked enhancement in c. (d) Photograph of the resected specimen shows the homogeneous, polypoid myxoma with a narrow pedicle (arrow). Scale is in centimeters.

View larger version (119K): [in a new window]   Figure 3c.   Left ventricular myxoma in a 41-year-old man. (a) Transesophageal echocardiogram (four-chamber view) centered on the left ventricle shows a pedunculated mass (arrowhead) with a faintly visible stalk arising from the lateral wall of the left ventricle (arrows). (b, c) Unenhanced (b) and contrast-enhanced (c) T1-weighted MR images demonstrate the small mass attached to the lateral wall of the left ventricle (arrow). The mass shows marked enhancement in c. (d) Photograph of the resected specimen shows the homogeneous, polypoid myxoma with a narrow pedicle (arrow). Scale is in centimeters.

View larger version (119K): [in a new window]   Figure 3d.   Left ventricular myxoma in a 41-year-old man. (a) Transesophageal echocardiogram (four-chamber view) centered on the left ventricle shows a pedunculated mass (arrowhead) with a faintly visible stalk arising from the lateral wall of the left ventricle (arrows). (b, c) Unenhanced (b) and contrast-enhanced (c) T1-weighted MR images demonstrate the small mass attached to the lateral wall of the left ventricle (arrow). The mass shows marked enhancement in c. (d) Photograph of the resected specimen shows the homogeneous, polypoid myxoma with a narrow pedicle (arrow). Scale is in centimeters.

View larger version (127K): [in a new window]   Figure 4a.   Left atrial papillary fibroelastoma in a 66-year-old woman. (a) Transverse transesophageal echocardiogram shows a small, pedunculated mass (white arrow) arising from the lateral wall of the left atrium (LA) near the mouth of the left atrial appendage (black arrow). (b) T1-weighted MR image reveals the mass in the same position (small arrow) (cf a). Large arrow indicates the left atrial appendage.

View larger version (140K): [in a new window]   Figure 4b.   Left atrial papillary fibroelastoma in a 66-year-old woman. (a) Transverse transesophageal echocardiogram shows a small, pedunculated mass (white arrow) arising from the lateral wall of the left atrium (LA) near the mouth of the left atrial appendage (black arrow). (b) T1-weighted MR image reveals the mass in the same position (small arrow) (cf a). Large arrow indicates the left atrial appendage.

View larger version (149K): [in a new window]   Figure 5a.   Left ventricular fibroma in a 7-year-old boy. (a) Transesophageal echocardiogram (four-chamber view oriented with the apex downward) obtained during systole shows a large, homogeneous mass arising from the interventricular septum and protruding into the left ventricular cavity (arrow). LA = left atrium, RA = right atrium, RV = right ventricle. (b) T1-weighted MR image shows diffuse thickening of the interventricular septum, left ventricular apex, and lateral wall. (c) Photograph of the resected specimen shows the dense, firm, white fibroma with a whorled cut surface. Scale is in centimeters.

View larger version (128K): [in a new window]   Figure 5b.   Left ventricular fibroma in a 7-year-old boy. (a) Transesophageal echocardiogram (four-chamber view oriented with the apex downward) obtained during systole shows a large, homogeneous mass arising from the interventricular septum and protruding into the left ventricular cavity (arrow). LA = left atrium, RA = right atrium, RV = right ventricle. (b) T1-weighted MR image shows diffuse thickening of the interventricular septum, left ventricular apex, and lateral wall. (c) Photograph of the resected specimen shows the dense, firm, white fibroma with a whorled cut surface. Scale is in centimeters.

View larger version (164K): [in a new window]   Figure 5c.   Left ventricular fibroma in a 7-year-old boy. (a) Transesophageal echocardiogram (four-chamber view oriented with the apex downward) obtained during systole shows a large, homogeneous mass arising from the interventricular septum and protruding into the left ventricular cavity (arrow). LA = left atrium, RA = right atrium, RV = right ventricle. (b) T1-weighted MR image shows diffuse thickening of the interventricular septum, left ventricular apex, and lateral wall. (c) Photograph of the resected specimen shows the dense, firm, white fibroma with a whorled cut surface. Scale is in centimeters.

View larger version (138K): [in a new window]   Figure 6a.   Left ventricular fibroma in a 55-year-old man. (a) Transesophageal echocardiogram (apical four-chamber view) demonstrates a large, homogeneous mass arising from the lateral wall of the left ventricle (LV) (arrow). LA = left atrium, RA = right atrium, RV = right ventricle. (Reprinted, with permission, from reference 4.) (b) Unenhanced electron beam CT scan shows coarse calcifications in the region of the lateral wall of the left ventricle (arrow). (c) On a contrast-enhanced CT scan, the calcifications are seen within the large, low-attenuation mass, which diffusely replaces the lateral wall (arrow). (d) T1-weighted MR image shows the homogeneous, low-signal-intensity mass in the lateral wall of the left ventricle (arrow).

View larger version (141K): [in a new window]   Figure 6b.   Left ventricular fibroma in a 55-year-old man. (a) Transesophageal echocardiogram (apical four-chamber view) demonstrates a large, homogeneous mass arising from the lateral wall of the left ventricle (LV) (arrow). LA = left atrium, RA = right atrium, RV = right ventricle. (Reprinted, with permission, from reference 4.) (b) Unenhanced electron beam CT scan shows coarse calcifications in the region of the lateral wall of the left ventricle (arrow). (c) On a contrast-enhanced CT scan, the calcifications are seen within the large, low-attenuation mass, which diffusely replaces the lateral wall (arrow). (d) T1-weighted MR image shows the homogeneous, low-signal-intensity mass in the lateral wall of the left ventricle (arrow).

View larger version (129K): [in a new window]   Figure 6c.   Left ventricular fibroma in a 55-year-old man. (a) Transesophageal echocardiogram (apical four-chamber view) demonstrates a large, homogeneous mass arising from the lateral wall of the left ventricle (LV) (arrow). LA = left atrium, RA = right atrium, RV = right ventricle. (Reprinted, with permission, from reference 4.) (b) Unenhanced electron beam CT scan shows coarse calcifications in the region of the lateral wall of the left ventricle (arrow). (c) On a contrast-enhanced CT scan, the calcifications are seen within the large, low-attenuation mass, which diffusely replaces the lateral wall (arrow). (d) T1-weighted MR image shows the homogeneous, low-signal-intensity mass in the lateral wall of the left ventricle (arrow).

View larger version (151K): [in a new window]   Figure 6d.   Left ventricular fibroma in a 55-year-old man. (a) Transesophageal echocardiogram (apical four-chamber view) demonstrates a large, homogeneous mass arising from the lateral wall of the left ventricle (LV) (arrow). LA = left atrium, RA = right atrium, RV = right ventricle. (Reprinted, with permission, from reference 4.) (b) Unenhanced electron beam CT scan shows coarse calcifications in the region of the lateral wall of the left ventricle (arrow). (c) On a contrast-enhanced CT scan, the calcifications are seen within the large, low-attenuation mass, which diffusely replaces the lateral wall (arrow). (d) T1-weighted MR image shows the homogeneous, low-signal-intensity mass in the lateral wall of the left ventricle (arrow).

View larger version (87K): [in a new window]   Figure 7a.   Right atrial paraganglioma in a 27-year-old woman. (a) Whole-body I-123 MIBG scan shows an abnormal focus of increased uptake in the right side of the mediastinum (arrow). Uptake in the liver, left side of the heart, gastrointestinal tract, salivary glands, and bladder is normal. (b) Axial single-photon-emission tomogram through the chest shows an abnormal focus of increased uptake in the right side of the heart (arrow). Uptake in the left ventricular myocardium is normal (arrowhead). (c) Transverse transesophageal echocardiogram obtained during systole shows a homogeneous, broad-based mass in the posterolateral right atrium (RA) adjacent to the tricuspid valve (arrow). RV = right ventricle. (d) Cine phase-contrast MR image shows the broad-based mass in the right atrium (arrow). (e) Photograph of the resected specimen shows the circumscribed, characteristically tan-brown paraganglioma with a central scar. A portion of the excised right atrial wall is included in the specimen (arrow). Scale is in centimeters.

View larger version (114K): [in a new window]   Figure 7b.   Right atrial paraganglioma in a 27-year-old woman. (a) Whole-body I-123 MIBG scan shows an abnormal focus of increased uptake in the right side of the mediastinum (arrow). Uptake in the liver, left side of the heart, gastrointestinal tract, salivary glands, and bladder is normal. (b) Axial single-photon-emission tomogram through the chest shows an abnormal focus of increased uptake in the right side of the heart (arrow). Uptake in the left ventricular myocardium is normal (arrowhead). (c) Transverse transesophageal echocardiogram obtained during systole shows a homogeneous, broad-based mass in the posterolateral right atrium (RA) adjacent to the tricuspid valve (arrow). RV = right ventricle. (d) Cine phase-contrast MR image shows the broad-based mass in the right atrium (arrow). (e) Photograph of the resected specimen shows the circumscribed, characteristically tan-brown paraganglioma with a central scar. A portion of the excised right atrial wall is included in the specimen (arrow). Scale is in centimeters.

View larger version (93K): [in a new window]   Figure 7c.   Right atrial paraganglioma in a 27-year-old woman. (a) Whole-body I-123 MIBG scan shows an abnormal focus of increased uptake in the right side of the mediastinum (arrow). Uptake in the liver, left side of the heart, gastrointestinal tract, salivary glands, and bladder is normal. (b) Axial single-photon-emission tomogram through the chest shows an abnormal focus of increased uptake in the right side of the heart (arrow). Uptake in the left ventricular myocardium is normal (arrowhead). (c) Transverse transesophageal echocardiogram obtained during systole shows a homogeneous, broad-based mass in the posterolateral right atrium (RA) adjacent to the tricuspid valve (arrow). RV = right ventricle. (d) Cine phase-contrast MR image shows the broad-based mass in the right atrium (arrow). (e) Photograph of the resected specimen shows the circumscribed, characteristically tan-brown paraganglioma with a central scar. A portion of the excised right atrial wall is included in the specimen (arrow). Scale is in centimeters.

View larger version (113K): [in a new window]   Figure 7d.   Right atrial paraganglioma in a 27-year-old woman. (a) Whole-body I-123 MIBG scan shows an abnormal focus of increased uptake in the right side of the mediastinum (arrow). Uptake in the liver, left side of the heart, gastrointestinal tract, salivary glands, and bladder is normal. (b) Axial single-photon-emission tomogram through the chest shows an abnormal focus of increased uptake in the right side of the heart (arrow). Uptake in the left ventricular myocardium is normal (arrowhead). (c) Transverse transesophageal echocardiogram obtained during systole shows a homogeneous, broad-based mass in the posterolateral right atrium (RA) adjacent to the tricuspid valve (arrow). RV = right ventricle. (d) Cine phase-contrast MR image shows the broad-based mass in the right atrium (arrow). (e) Photograph of the resected specimen shows the circumscribed, characteristically tan-brown paraganglioma with a central scar. A portion of the excised right atrial wall is included in the specimen (arrow). Scale is in centimeters.

View larger version (147K): [in a new window]   Figure 7e.   Right atrial paraganglioma in a 27-year-old woman. (a) Whole-body I-123 MIBG scan shows an abnormal focus of increased uptake in the right side of the mediastinum (arrow). Uptake in the liver, left side of the heart, gastrointestinal tract, salivary glands, and bladder is normal. (b) Axial single-photon-emission tomogram through the chest shows an abnormal focus of increased uptake in the right side of the heart (arrow). Uptake in the left ventricular myocardium is normal (arrowhead). (c) Transverse transesophageal echocardiogram obtained during systole shows a homogeneous, broad-based mass in the posterolateral right atrium (RA) adjacent to the tricuspid valve (arrow). RV = right ventricle. (d) Cine phase-contrast MR image shows the broad-based mass in the right atrium (arrow). (e) Photograph of the resected specimen shows the circumscribed, characteristically tan-brown paraganglioma with a central scar. A portion of the excised right atrial wall is included in the specimen (arrow). Scale is in centimeters.

View larger version (126K): [in a new window]   Figure 8.   Right atrial lipoma in a 60-year-old man. Unenhanced CT scan shows a fat-attenuation mass filling most of the right atrium (arrow).

View larger version (150K): [in a new window]   Figure 9a.   Right atrial lipoma in a 72-year-old man. (a) Transesophageal echocardiogram (apical four-chamber view) shows a large mass (M) arising from the posterolateral wall of the right atrium (arrow). LA = left atrium, LV = left ventricle, RV = right ventricle. (b) T1-weighted MR image shows the circumscribed, broad-based mass with increased signal intensity (arrow). The mass appears similar to the mediastinal fat and fills most of the right atrium. (c) Intraoperative photograph shows the smooth lipoma filling the right atrium (arrow). (Figure 9 reprinted, with permission, from reference 5.)

View larger version (164K): [in a new window]   Figure 9b.   Right atrial lipoma in a 72-year-old man. (a) Transesophageal echocardiogram (apical four-chamber view) shows a large mass (M) arising from the posterolateral wall of the right atrium (arrow). LA = left atrium, LV = left ventricle, RV = right ventricle. (b) T1-weighted MR image shows the circumscribed, broad-based mass with increased signal intensity (arrow). The mass appears similar to the mediastinal fat and fills most of the right atrium. (c) Intraoperative photograph shows the smooth lipoma filling the right atrium (arrow). (Figure 9 reprinted, with permission, from reference 5.)

View larger version (152K): [in a new window]   Figure 9c.   Right atrial lipoma in a 72-year-old man. (a) Transesophageal echocardiogram (apical four-chamber view) shows a large mass (M) arising from the posterolateral wall of the right atrium (arrow). LA = left atrium, LV = left ventricle, RV = right ventricle. (b) T1-weighted MR image shows the circumscribed, broad-based mass with increased signal intensity (arrow). The mass appears similar to the mediastinal fat and fills most of the right atrium. (c) Intraoperative photograph shows the smooth lipoma filling the right atrium (arrow). (Figure 9 reprinted, with permission, from reference 5.)

View larger version (130K): [in a new window]   Figure 10a.   Pericardial lymphangioma in a 76-year-old man. (a) Transesophageal echocardiogram (apical long-axis view) shows a heterogeneous extracardiac mass abutting or invading the inferolateral wall of the left ventricle (LV) and left atrium (LA) (arrows). (b, c) Axial (b) and coronal (c) T1-weighted MR images show the heterogeneous, lobulated mass in the pericardial space (arrows).

View larger version (163K): [in a new window]   Figure 10b.   Pericardial lymphangioma in a 76-year-old man. (a) Transesophageal echocardiogram (apical long-axis view) shows a heterogeneous extracardiac mass abutting or invading the inferolateral wall of the left ventricle (LV) and left atrium (LA) (arrows). (b, c) Axial (b) and coronal (c) T1-weighted MR images show the heterogeneous, lobulated mass in the pericardial space (arrows).

View larger version (159K): [in a new window]   Figure 10c.   Pericardial lymphangioma in a 76-year-old man. (a) Transesophageal echocardiogram (apical long-axis view) shows a heterogeneous extracardiac mass abutting or invading the inferolateral wall of the left ventricle (LV) and left atrium (LA) (arrows). (b, c) Axial (b) and coronal (c) T1-weighted MR images show the heterogeneous, lobulated mass in the pericardial space (arrows).