0521779407-C01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53
284 Cardiac Tumors■physical exam depends on location of tumor and may be positional
➣tumor plop – low pitched sound occurring after S2, occurring
later than an opening snap
➣if tumor located near tricuspid valve – symptoms of right-sided
failure such as hepatomegaly, ascites
➣tumor located in left atrium (usually myxoma) – symptoms of
mitral stenosis such as opening snap, loud first heart sound, rales,
and diastolic rumbletests
■Basic blood tests
➣hypergammaglobulinemia
➣elevated erythrocyte sedimentation rate
➣thrombocytosis or thrombocytopenia
➣polycythemia
➣leukocytosis
➣anemia
Imaging
■CXR
➣alterations in cardiac contour, chambers, mediastinal widening,
calcifications
■Transthoracic echo (TTE)
➣provides information regarding tumor size, attachment, and
mobility to allow operative resection
➣sensitive for detection of small tumors, especially in left ventricle
or non-prolapsing tumors
➣can differentiate between left atrial thrombus and myxoma
■Transesophageal echo (TEE)
➣obtain if TTE study is suboptimal or confusing
➣improved resolution of tumor and attachment
➣can detect some masses not visualized by TTE
➣improved visualization of right atrial tumors
➣superior for anatomic details such as tumor contour, cysts, cal-
cification, and stalk
■Radionuclide imaging
➣Lower rate of resolution than echo or angiography
■CT
➣use to determine the degree of myocardial invasion and the
involvement of pericardial and extracardiac structures
➣high degree of tissue discrimination and evaluation of extracar-
diac structures