Internal Medicine

0521779407-C01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53

Cardiac Tumors 285

■MRI

➣provides larger field of view

➣can be useful to define tumor prolapse, secondary valve obstruc-

tion, and cardiac chamber size

➣may depict size, shape, and surface characteristics of tumor more

clearly than TTE

■Cardiac Catheterization

➣obtain if noninvasive evaluation is inadequate

➣suggested if malignant cardiac tumor considered likely

➣findings include compression of cardiac chambers or large ves-

sels, intracavitary filling defects, variations in myocardial thick-

ness, pericardial effusion, and wall motion abnormalities

➣risk of peripheral embolization due to dislodgement

■Pericardiocentesis with fluid cytology if large pericardial effusion is

present

■Endomyocardial biopsy to diagnose metastatic tumors

differential diagnosis

■Rheumatic heart disease

■Pulmonary hypertension

■Cerebrovascular disease

■Endocarditis

■Vasculitis

■Pericarditis

■Pulmonary embolus

■Mural thrombus

■Carcinoid heart disease

■Valvular heart disease (i.e. MS, MR, etc.)

■Cardiomyopathy

management

What to Do First

■visualization usually with echocardiography

General Measures

■refer for prompt surgical removal if appropriate

■followup echocardiography to exclude recurrence

specific therapy

■Benign Tumors

➣operative excision (Rx of choice)

➣in many cases, results in complete cure