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Non-invasive imaging
Cardiac masses: an integrative approach using echocardiography and other imaging modalities
  1. Dominique Auger1,
  2. Josephine Pressacco2,
  3. François Marcotte1,
  4. Annie Tremblay1,
  5. Annie Dore1,
  6. Anique Ducharme1
  1. 1Department of Medicine, Montreal Heart Institute, University of Montreal, Montreal, Canada
  2. 2Department of Radiology, Montreal Heart Institute, University of Montreal, Montreal, Canada
  1. Correspondence to Dr Anique Ducharme, Montreal Heart Institute, 5000 rue Bélanger Est, Montréal, Québec H1T 1C8, Canada; a_ducharme{at}icm-mhi.com

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Echocardiography has been and remains an invaluable tool for cardiac evaluation, including characterisation of cardiac masses. Even if most cardiac masses are considered benign, significant morbidity related to obstruction, infiltration, thromboembolism, arrhythmias and even death may occur. Therefore, a rapid and precise diagnosis is mandatory. Echocardiography enables key questions regarding the mass to be answered, such as: location, size, mobility, haemodynamic consequences and differentiation with extra-cardiac disease, embryologic remnants or artefacts. Recent advances in computed tomography (CT) and cardiac magnetic resonance (CMR) may help in the further characterisation of cardiac masses. This article presents challenging cases encountered at the Montreal Heart Institute between 2005 and 2008; we discuss the differential diagnosis of each mass and the current role of echocardiography, cardiac CT, and cardiac MRI (table 1).

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Table 1

Evaluation of seven cardiac masses through transthoracic echocardiography (TTE), transoesophageal echocardiography (TOE), cardiac magnetic resonance imaging (CMR), and computed tomography (CT) scan

Case 1

A middle age person underwent an uneventful left atrial myxoma resection many years ago, without any residual mass on follow-up transthoracic echocardiography (TTE) performed 1 year after. A few months later' however, she complained of non-specific symptoms of fatigue, shortness of breath, and atypical chest pain. Symptoms such as fever, weight loss or neurological problems were denied. Physical examination, ECG and chest x-ray were normal. Repeat TTE (figure 1, video 1) depicted a sessile bi-lobar, non-obstructive and immobile mass in the left atrium, with suspected right atrium extension. A transoesophageal echocardiogram (TOE) confirmed the 11×9 mm slightly mobile mass attached posteriorly to the interatrial septum, on the left atrial side. A recurrent myxoma was suspected, but neither a thrombus nor a sarcoma could be excluded, given the rapid growth of this mass. CMR further delineated this left atrial irregular mass, originating from the interatrial septum, hypointense on T1 weighted and hyperintense …

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