DK2985_C000 1..28 - AlSharqia Echo Club

Intracavitary Contents 505(A)(B)MYXOMAAoVRARVLV(E)CATHETER(C)(D)MYXOMALAAoLVRVCATHETERFigure 23.12 (A–D) Mid-esophageal views of a 61-year-old woman with a large left atrial myxoma occupying almost all the atrialcavity. (E) Intraoperative aspect (Ao, aorta; AoV, aortic valve; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle).Multiple tumors can be found in the same chamber or indifferent chambers. As multifocal myxomas have beenreported in up to 5% of patients, a complete examinationof all four chambers is mandatory. The most commonpattern is biatrial. Recurrence of tumors after surgicalresection has been reported in 5–14% of cases, at thesite of the original tumor, at multiple intracardiac sites,or even at extracardiac sites (10–12). Serial follow-upechocardiographic studies are, therefore, recommendedafter surgical treatment.2. FibromasNearly all cardiac fibromas present as a solitary massinvolving the ventricular myocardium, frequently in theseptum, the apex or the LV free wall. Sometimes, theygrow within the LV cavity and interfere with filling. Ontwo-dimensional (2D) echocardiography, they are recognizedas a large mass of echoes well demarcated fromthe surrounding myocardium by multiple calcifications(Fig. 23.13) (5), which may be difficult to differentiatefrom a solitary rhabdomyoma. When located at the apex,they can mimic the apical form of hypertrophic cardiomyopathy.Cardiac fibromas can occur in patients of allages and sexes. They are more frequent in children,being the second most common primary cardiac tumor inthe pediatric age group (10–12).3. RhabdomyomasRhabdomyomas represent the most common benigncardiac tumors in infants and children. It is uncommonto find them at the atrial level as they tend to occur inthe ventricles. No cases of rhabdomyomas attached tothe valves have been reported. Most patients have multipletumors occurring with nearly equal frequency in the RVand LV, including the ventricular septum. They can beintramural or intracavitary. Rhabdomyomas can presentas a solitary intramural echodense mass in the ventricularseptum or the LV free wall. A strong association betweenrhabdomyomas and tuberous sclerosis have been described(11,12).4. LipomasCardiac lipomas occur most frequently in the LV or theRA but can be seen throughout the heart including the pericardium.Rarely, they have also been found attached to thevalves. These benign tumors occur at all ages and are seenwith equal frequency in men and women. Cardiac lipomascan be subendocardial and have a sessile appearance. Theycan also present as a large subepicardial pedunculatedmass. Approximately 25% of lipomas are completelyintramyocardial. Compared with LV myxomas, lipomasare less mobile and generally more echodense but the