Cardiac tumors can be primary tumors originating from the heart or secondary tumors from metastases. Primary tumors are more commonly benign myxomas found in the left atrium of middle aged patients, while secondary tumors are more prevalent. Imaging with echocardiography, CT, and MRI can characterize tumors and determine if they are resectable. MRI provides the best evaluation of tumor extent, involvement of surrounding structures, and differentiation of tumor types.
The document discusses diagnostic criteria for acute and chronic pulmonary embolism (PE) based on CT imaging findings. For acute PE, findings include complete arterial occlusion seen as an enlarged artery, partial filling defects known as the "polo mint" or "railway track" signs, and peripheral intraluminal defects. Chronic PE criteria consist of complete occlusions that are smaller than adjacent vessels, peripheral crescent-shaped defects, recanalized smaller arteries, webs or flaps, and bronchial collaterals. The document also reviews methods of assessing PE severity including pulmonary artery clot load scores and signs of right heart strain. Common causes of misdiagnosing PE include mimic pathologies and technical imaging factors.
This document summarizes CT findings that are useful for diagnosing chronic pulmonary thromboembolism (CPTE). It describes risk factors, clinical manifestations, and CT features of CPTE including vascular signs like pulmonary artery obstruction and dilation, parenchymal signs like scarring and mosaic perfusion patterns, and signs of pulmonary hypertension. Differential diagnoses including idiopathic pulmonary hypertension and acute PE are also discussed. CT is important for identifying treatable CPTE in patients with unexplained pulmonary hypertension.
1) Pulmonary embolism occurs when a blood clot lodges in the pulmonary arteries, often originating from deep vein thromboses. It can be difficult to diagnose due to non-specific symptoms.
2) Evaluation involves assessing clinical probability, D-dimer levels, and imaging. D-dimers are elevated in pulmonary embolism but nonspecific. Imaging options include CT pulmonary angiography, ventilation-perfusion scanning, and pulmonary angiography.
3) CT pulmonary angiography has become the initial test of choice due to its high sensitivity and specificity for detecting emboli as well as being readily available and minimally invasive. Ventilation-perfusion scanning provides functional information and has a lower radiation dose
1. CT is the imaging modality of choice for diagnosing aortic dissection, allowing visualization of the intimal flap and differentiation of the true and false lumens.
2. Key CT findings include an intimal flap that separates the true and false lumens, as well as complications such as periaortic hematoma.
3. ECG gating is important to minimize motion artifacts and accurately characterize the proximal extent of the dissection and involvement of coronary arteries.
Contrast-enhanced, cardiac-gated CT is highly accurate for determining the cause of acute aortic syndrome, which can be due to aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, or unstable thoracic aneurysm. CT accurately identifies the location and extent of disease and guides urgent surgical or endovascular repair when needed to treat life-threatening conditions such as type A aortic dissection or ruptured aneurysm.
This document provides definitions and classifications for solitary pulmonary nodules (SPNs) seen on CT scans. It discusses the differential diagnosis and characteristics of solid and subsolid SPNs that can help determine if they are likely benign or malignant. Size, location, edge characteristics, calcification patterns, attenuation, presence of air bronchograms or cavitation, and contrast enhancement can all provide clues. Evaluation involves considering the patient's clinical history and risk factors as well as radiological features of the SPN. Biopsy may be needed if features are indeterminate between benign and malignant possibilities.
This document discusses various types of primary cardiac tumors. It begins by stating that myxomas are the most common type of benign primary cardiac tumor, accounting for around 50% of cases. Myxomas most often originate in the left atrium. Papillary fibroelastomas are the second most common primary cardiac tumor, usually arising from heart valves. Rhabdomyomas are more common in pediatric patients under 1 year of age and often involve both ventricles. Echocardiography and MRI are useful imaging modalities for evaluating cardiac tumors.
This document provides an overview of radiological signs and patterns seen in various pulmonary and chest diseases. It describes features of cavitary lung lesions, pleural effusions, lung masses, atelectasis, pneumothorax, and other conditions. Key signs are highlighted, such as the silhouette sign for localizing lung lesions. Common distributions and appearances of diseases are outlined, along with tips for distinguishing various diagnostic possibilities based on radiographic interpretation.
The document discusses diagnostic criteria for acute and chronic pulmonary embolism (PE) based on CT imaging findings. For acute PE, findings include complete arterial occlusion seen as an enlarged artery, partial filling defects known as the "polo mint" or "railway track" signs, and peripheral intraluminal defects. Chronic PE criteria consist of complete occlusions that are smaller than adjacent vessels, peripheral crescent-shaped defects, recanalized smaller arteries, webs or flaps, and bronchial collaterals. The document also reviews methods of assessing PE severity including pulmonary artery clot load scores and signs of right heart strain. Common causes of misdiagnosing PE include mimic pathologies and technical imaging factors.
This document summarizes CT findings that are useful for diagnosing chronic pulmonary thromboembolism (CPTE). It describes risk factors, clinical manifestations, and CT features of CPTE including vascular signs like pulmonary artery obstruction and dilation, parenchymal signs like scarring and mosaic perfusion patterns, and signs of pulmonary hypertension. Differential diagnoses including idiopathic pulmonary hypertension and acute PE are also discussed. CT is important for identifying treatable CPTE in patients with unexplained pulmonary hypertension.
1) Pulmonary embolism occurs when a blood clot lodges in the pulmonary arteries, often originating from deep vein thromboses. It can be difficult to diagnose due to non-specific symptoms.
2) Evaluation involves assessing clinical probability, D-dimer levels, and imaging. D-dimers are elevated in pulmonary embolism but nonspecific. Imaging options include CT pulmonary angiography, ventilation-perfusion scanning, and pulmonary angiography.
3) CT pulmonary angiography has become the initial test of choice due to its high sensitivity and specificity for detecting emboli as well as being readily available and minimally invasive. Ventilation-perfusion scanning provides functional information and has a lower radiation dose
1. CT is the imaging modality of choice for diagnosing aortic dissection, allowing visualization of the intimal flap and differentiation of the true and false lumens.
2. Key CT findings include an intimal flap that separates the true and false lumens, as well as complications such as periaortic hematoma.
3. ECG gating is important to minimize motion artifacts and accurately characterize the proximal extent of the dissection and involvement of coronary arteries.
Contrast-enhanced, cardiac-gated CT is highly accurate for determining the cause of acute aortic syndrome, which can be due to aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, or unstable thoracic aneurysm. CT accurately identifies the location and extent of disease and guides urgent surgical or endovascular repair when needed to treat life-threatening conditions such as type A aortic dissection or ruptured aneurysm.
This document provides definitions and classifications for solitary pulmonary nodules (SPNs) seen on CT scans. It discusses the differential diagnosis and characteristics of solid and subsolid SPNs that can help determine if they are likely benign or malignant. Size, location, edge characteristics, calcification patterns, attenuation, presence of air bronchograms or cavitation, and contrast enhancement can all provide clues. Evaluation involves considering the patient's clinical history and risk factors as well as radiological features of the SPN. Biopsy may be needed if features are indeterminate between benign and malignant possibilities.
This document discusses various types of primary cardiac tumors. It begins by stating that myxomas are the most common type of benign primary cardiac tumor, accounting for around 50% of cases. Myxomas most often originate in the left atrium. Papillary fibroelastomas are the second most common primary cardiac tumor, usually arising from heart valves. Rhabdomyomas are more common in pediatric patients under 1 year of age and often involve both ventricles. Echocardiography and MRI are useful imaging modalities for evaluating cardiac tumors.
This document provides an overview of radiological signs and patterns seen in various pulmonary and chest diseases. It describes features of cavitary lung lesions, pleural effusions, lung masses, atelectasis, pneumothorax, and other conditions. Key signs are highlighted, such as the silhouette sign for localizing lung lesions. Common distributions and appearances of diseases are outlined, along with tips for distinguishing various diagnostic possibilities based on radiographic interpretation.
Primary cardiac tumors are rare but can involve the heart directly or through metastasis. Benign tumors like myxomas are the most common primary cardiac tumors and often present with nonspecific symptoms of obstruction, embolism, or constitutional effects. Myxomas typically occur in the left atrium of middle-aged women and can be part of Carney syndrome, characterized by extracardiac tumors and skin pigmentation. Echocardiography is the primary diagnostic tool used to identify location and characteristics of a suspected cardiac tumor.
The document discusses the anatomy of the mediastinum, which is the central compartment of the thoracic cavity located between the lungs. It describes how the mediastinum is divided into three compartments - superior, anterior, and posterior. Each compartment contains different structures like blood vessels, lymph nodes, and organs. Computed tomography (CT) is often used to further examine abnormalities detected on chest x-rays by providing detailed images of mediastinal structures and lesions in axial, coronal, and sagittal planes. Key CT features of various mediastinal structures are also outlined.
This document discusses solitary pulmonary nodules (SPNs), which are round lung opacities smaller than 3 cm. SPNs are found in 1-2% of chest x-rays. Characteristics like size, margins, calcification, and growth rate help determine if an SPN is benign or malignant. Initial evaluation involves a CT scan to assess these characteristics. Follow up scans or biopsy may be needed for indeterminate nodules. Combined CT and PET scanning provides accurate evaluation of SPNs.
This document provides an overview of lung neoplasms, including their epidemiology, etiology, pathology, clinical presentations, and radiological features. It discusses the main types of malignant lung tumors such as squamous cell carcinoma, adenocarcinoma, large cell carcinoma, and small cell carcinoma. It also briefly covers preinvasive lesions such as atypical adenomatous hyperplasia, adenocarcinoma in situ, and diffuse idiopathic pulmonary neuroendocrine cell hyperplasia which are considered precursors to lung cancer.
A solitary pulmonary nodule is a rounded opacity less than 3 cm in diameter surrounded by lung parenchyma. Differentiating between benign and malignant nodules is important for prognosis and treatment. CT is the preferred imaging method and can evaluate nodule characteristics like size, shape, margin, attenuation and the presence of calcification which provide clues to benign or malignant etiology. Benign nodules often demonstrate smooth margins and characteristic calcification patterns while malignant nodules tend to have spiculated margins, irregular shapes and other concerning imaging features requiring biopsy for diagnosis.
A solitary pulmonary nodule is a rounded opacity in the lung less than 3 cm in diameter that is surrounded by lung tissue. Most nodules are benign, but some may be early-stage lung cancer. Evaluation involves imaging like CT scans to characterize the nodule based on size, growth rate, borders, and internal features. Biopsy may be needed. Small, stable nodules may only require follow up scans, while larger or growing nodules may require surgery to remove and test the nodule. Finding the nodule early allows the best chance of curing potential lung cancer.
1) HRCT shows reticular pattern involving subpleural areas of the superior segment of lower lobes with some interlobular septal thickening, suggestive of usual interstitial pneumonia.
2) There is also a reticular pattern with tractional bronchiectasis and subpleural sparing with surrounding areas of fibrosis, consistent with fibrotic nonspecific interstitial pneumonia.
3) Small multifocal areas show the "atoll sign" with central ground glass opacity and thick-walled cysts, seen in conditions like bronchiolitis obliterans organizing pneumonia, especially in an immune compromised patient.
Carotid ultrasound is used to detect plaque buildup in the carotid arteries, which can harden or rupture over time and increase the risk of stroke. Plaque can narrow the arteries and reduce blood flow to the brain. Ruptured plaque can also form blood clots, which may block or partially block the carotid artery and cause a stroke if pieces of plaque or clots break off and travel to the brain. Carotid ultrasound is recommended for those who have had a stroke or mini-stroke, have an abnormal carotid bruit sound, blood clots in the carotid arteries, or a dissection in the carotid artery wall. Ultrasound images show normal versus abnormal carotid arteries, including plaque buildup, ulcerations
Pulmonary embolism is a blockage of the pulmonary artery or its branches by material that has traveled from elsewhere in the body through the bloodstream. It is most commonly caused by deep vein thrombosis in the legs. Symptoms include dyspnea, chest pain, and cough. Risk factors include prolonged bed rest, cancer, oral contraceptives, and recent surgery or trauma. Diagnosis involves evaluating clinical probability and testing such as D-dimer, CT pulmonary angiography, ventilation-perfusion scanning, and pulmonary angiography. Treatment focuses on anticoagulation to prevent further clots.
This document discusses pulmonary tumors, including:
1. It categorizes pulmonary tumors into malignant tumors, low-grade malignancies, and benign tumors. The main malignant tumors discussed are bronchogenic carcinoma, bronchoalveolar carcinoma, lymphoma, metastases, and rare sarcomas.
2. Bronchogenic carcinoma is further broken down by classification, risk factors, location, and radiographic findings. The classifications include adenocarcinoma, squamous cell carcinoma, small cell carcinoma, large cell carcinoma, and adenosquamous tumor. Cavitation and air bronchograms are among the key radiographic findings.
3. Pancoast tumors, a type of superior sulcus tumor, are defined as tumors located
This document summarizes the diagnostic imaging characteristics of different types of lung cancer. It discusses:
- Adenocarcinoma typically presents as a peripheral nodule under 4cm in diameter on CT. Bronchoalveolar carcinoma presents as a solitary nodule, multifocal disease, or localized consolidation with bubble-like low attenuation areas.
- Squamous cell carcinoma is often centrally located, larger than 4cm, and cavitates in up to 82%. Small cell lung cancer presents with bulky hilar and mediastinal lymph nodes and rarely cavitates.
- Imaging techniques like chest x-rays, CT, MRI, and PET scans are used to diagnose and stage lung cancers. CT is
The document describes the anatomy and function of the heart. It discusses the four chambers of the heart, including the right and left atria separated by the interatrial septum and the right and left ventricles separated by the interventricular septum. It also describes the four heart valves - the mitral and tricuspid valves between the atria and ventricles, and the aortic and pulmonary valves at the exits of the ventricles.
This document provides guidance on properly conducting and interpreting chest x-rays for cardiovascular diseases. It outlines how to ensure ideal exposure, centering and labeling of x-rays. It describes how to evaluate lung fields, the cardiovascular silhouette and other structures. Specific abnormalities are also discussed like pulmonary edema, pulmonary hypertension and various congenital heart diseases. Proper technique is emphasized to obtain diagnostic quality images for cardiovascular assessment.
This document provides information on pleural lesions, including pleural effusions, hemothorax, empyema, and chylothorax. Key points include:
- Pleural effusions can be transudative or exudative based on protein and LDH levels, and can be caused by tumors, inflammation, cardiovascular issues, congenital defects, trauma or metabolic problems.
- Empyema is an infected pleural effusion that progresses through exudative, fibrinopurulent and fibrinous stages. It appears lenticular on x-ray and CT shows thickened, enhancing pleura.
- Chylothorax is the presence of chylous fluid in the ple
1. Myxomas are the most common primary cardiac tumor, usually occurring in the left atrium and presenting with signs and symptoms similar to mitral valve disease like dyspnea and murmurs.
2. Other common benign tumors include rhabdomyomas in children and lipomas, while sarcomas are the most common malignant cardiac tumors in adults presenting with rapid progression.
3. Metastatic tumors to the heart are more common than primary cardiac tumors, usually from melanoma and lung/breast cancers through hematogenous spread.
This document discusses primary cardiac tumors, including their presentation, diagnosis, and types. It covers the following key points:
- The majority (75%) of primary cardiac tumors are benign neoplasms. Myxomas are the most common benign tumor, usually originating in the left atrium.
- Clinical presentation varies depending on tumor location and can include embolic phenomena, cardiac manifestations like obstruction, or symptoms of metastatic disease. Echocardiography is the primary diagnostic tool.
- Other common benign primary tumors include papillary fibroelastomas (found on heart valves) and lipomas. Rhabdomyomas are most often seen in children with tuberous sclerosis and can cause arrhythmias
Radiological imaging of pulmonary neoplasmsPankaj Kaira
The document discusses radiological imaging of pulmonary neoplasms. It begins by noting that a wide variety of neoplasms can arise in the lungs, including both malignant and benign tumors. Bronchogenic carcinoma, specifically adenocarcinoma, squamous cell carcinoma, and small cell carcinoma, are the most common primary lung tumors. Imaging plays an important role in evaluating these tumors and detecting metastases. Common imaging findings on chest x-rays, CT scans, PET scans, and other modalities are described for different tumor types and locations within the lungs.
This document discusses pediatric abdominal tumors and provides information on evaluating and characterizing various tumors through imaging modalities like ultrasound, CT, and MRI. Key tumors mentioned include Wilm's tumor of the kidney, cystic nephroma, clear cell sarcoma, rhabdoid tumor, neuroblastoma, hepatoblastoma, hepatocellular carcinoma, lymphoma, leukemia, and rhabdomyosarcoma. Imaging findings for different tumors are outlined to help determine the tumor type and guide diagnosis and treatment.
This document summarizes the anatomy and imaging features of various adrenal gland lesions. It describes the typical appearance of the adrenal glands on CT and MRI. Common adrenal tumors like adenomas, carcinomas, pheochromocytomas, and metastases are discussed. Adenomas often appear lipid-rich on CT and demonstrate signal loss on opposed-phase MRI. Carcinomas usually appear large, inhomogeneous, and demonstrate central necrosis. Pheochromocytomas tend to be large and heterogeneous with areas of necrosis. Neuroblastomas often insinuate around vessels in children. Myelolipomas contain detectable fat. Distinguishing features between tumor types are highlighted.
Primary cardiac tumors are rare but can involve the heart directly or through metastasis. Benign tumors like myxomas are the most common primary cardiac tumors and often present with nonspecific symptoms of obstruction, embolism, or constitutional effects. Myxomas typically occur in the left atrium of middle-aged women and can be part of Carney syndrome, characterized by extracardiac tumors and skin pigmentation. Echocardiography is the primary diagnostic tool used to identify location and characteristics of a suspected cardiac tumor.
The document discusses the anatomy of the mediastinum, which is the central compartment of the thoracic cavity located between the lungs. It describes how the mediastinum is divided into three compartments - superior, anterior, and posterior. Each compartment contains different structures like blood vessels, lymph nodes, and organs. Computed tomography (CT) is often used to further examine abnormalities detected on chest x-rays by providing detailed images of mediastinal structures and lesions in axial, coronal, and sagittal planes. Key CT features of various mediastinal structures are also outlined.
This document discusses solitary pulmonary nodules (SPNs), which are round lung opacities smaller than 3 cm. SPNs are found in 1-2% of chest x-rays. Characteristics like size, margins, calcification, and growth rate help determine if an SPN is benign or malignant. Initial evaluation involves a CT scan to assess these characteristics. Follow up scans or biopsy may be needed for indeterminate nodules. Combined CT and PET scanning provides accurate evaluation of SPNs.
This document provides an overview of lung neoplasms, including their epidemiology, etiology, pathology, clinical presentations, and radiological features. It discusses the main types of malignant lung tumors such as squamous cell carcinoma, adenocarcinoma, large cell carcinoma, and small cell carcinoma. It also briefly covers preinvasive lesions such as atypical adenomatous hyperplasia, adenocarcinoma in situ, and diffuse idiopathic pulmonary neuroendocrine cell hyperplasia which are considered precursors to lung cancer.
A solitary pulmonary nodule is a rounded opacity less than 3 cm in diameter surrounded by lung parenchyma. Differentiating between benign and malignant nodules is important for prognosis and treatment. CT is the preferred imaging method and can evaluate nodule characteristics like size, shape, margin, attenuation and the presence of calcification which provide clues to benign or malignant etiology. Benign nodules often demonstrate smooth margins and characteristic calcification patterns while malignant nodules tend to have spiculated margins, irregular shapes and other concerning imaging features requiring biopsy for diagnosis.
A solitary pulmonary nodule is a rounded opacity in the lung less than 3 cm in diameter that is surrounded by lung tissue. Most nodules are benign, but some may be early-stage lung cancer. Evaluation involves imaging like CT scans to characterize the nodule based on size, growth rate, borders, and internal features. Biopsy may be needed. Small, stable nodules may only require follow up scans, while larger or growing nodules may require surgery to remove and test the nodule. Finding the nodule early allows the best chance of curing potential lung cancer.
1) HRCT shows reticular pattern involving subpleural areas of the superior segment of lower lobes with some interlobular septal thickening, suggestive of usual interstitial pneumonia.
2) There is also a reticular pattern with tractional bronchiectasis and subpleural sparing with surrounding areas of fibrosis, consistent with fibrotic nonspecific interstitial pneumonia.
3) Small multifocal areas show the "atoll sign" with central ground glass opacity and thick-walled cysts, seen in conditions like bronchiolitis obliterans organizing pneumonia, especially in an immune compromised patient.
Carotid ultrasound is used to detect plaque buildup in the carotid arteries, which can harden or rupture over time and increase the risk of stroke. Plaque can narrow the arteries and reduce blood flow to the brain. Ruptured plaque can also form blood clots, which may block or partially block the carotid artery and cause a stroke if pieces of plaque or clots break off and travel to the brain. Carotid ultrasound is recommended for those who have had a stroke or mini-stroke, have an abnormal carotid bruit sound, blood clots in the carotid arteries, or a dissection in the carotid artery wall. Ultrasound images show normal versus abnormal carotid arteries, including plaque buildup, ulcerations
Pulmonary embolism is a blockage of the pulmonary artery or its branches by material that has traveled from elsewhere in the body through the bloodstream. It is most commonly caused by deep vein thrombosis in the legs. Symptoms include dyspnea, chest pain, and cough. Risk factors include prolonged bed rest, cancer, oral contraceptives, and recent surgery or trauma. Diagnosis involves evaluating clinical probability and testing such as D-dimer, CT pulmonary angiography, ventilation-perfusion scanning, and pulmonary angiography. Treatment focuses on anticoagulation to prevent further clots.
This document discusses pulmonary tumors, including:
1. It categorizes pulmonary tumors into malignant tumors, low-grade malignancies, and benign tumors. The main malignant tumors discussed are bronchogenic carcinoma, bronchoalveolar carcinoma, lymphoma, metastases, and rare sarcomas.
2. Bronchogenic carcinoma is further broken down by classification, risk factors, location, and radiographic findings. The classifications include adenocarcinoma, squamous cell carcinoma, small cell carcinoma, large cell carcinoma, and adenosquamous tumor. Cavitation and air bronchograms are among the key radiographic findings.
3. Pancoast tumors, a type of superior sulcus tumor, are defined as tumors located
This document summarizes the diagnostic imaging characteristics of different types of lung cancer. It discusses:
- Adenocarcinoma typically presents as a peripheral nodule under 4cm in diameter on CT. Bronchoalveolar carcinoma presents as a solitary nodule, multifocal disease, or localized consolidation with bubble-like low attenuation areas.
- Squamous cell carcinoma is often centrally located, larger than 4cm, and cavitates in up to 82%. Small cell lung cancer presents with bulky hilar and mediastinal lymph nodes and rarely cavitates.
- Imaging techniques like chest x-rays, CT, MRI, and PET scans are used to diagnose and stage lung cancers. CT is
The document describes the anatomy and function of the heart. It discusses the four chambers of the heart, including the right and left atria separated by the interatrial septum and the right and left ventricles separated by the interventricular septum. It also describes the four heart valves - the mitral and tricuspid valves between the atria and ventricles, and the aortic and pulmonary valves at the exits of the ventricles.
This document provides guidance on properly conducting and interpreting chest x-rays for cardiovascular diseases. It outlines how to ensure ideal exposure, centering and labeling of x-rays. It describes how to evaluate lung fields, the cardiovascular silhouette and other structures. Specific abnormalities are also discussed like pulmonary edema, pulmonary hypertension and various congenital heart diseases. Proper technique is emphasized to obtain diagnostic quality images for cardiovascular assessment.
This document provides information on pleural lesions, including pleural effusions, hemothorax, empyema, and chylothorax. Key points include:
- Pleural effusions can be transudative or exudative based on protein and LDH levels, and can be caused by tumors, inflammation, cardiovascular issues, congenital defects, trauma or metabolic problems.
- Empyema is an infected pleural effusion that progresses through exudative, fibrinopurulent and fibrinous stages. It appears lenticular on x-ray and CT shows thickened, enhancing pleura.
- Chylothorax is the presence of chylous fluid in the ple
1. Myxomas are the most common primary cardiac tumor, usually occurring in the left atrium and presenting with signs and symptoms similar to mitral valve disease like dyspnea and murmurs.
2. Other common benign tumors include rhabdomyomas in children and lipomas, while sarcomas are the most common malignant cardiac tumors in adults presenting with rapid progression.
3. Metastatic tumors to the heart are more common than primary cardiac tumors, usually from melanoma and lung/breast cancers through hematogenous spread.
This document discusses primary cardiac tumors, including their presentation, diagnosis, and types. It covers the following key points:
- The majority (75%) of primary cardiac tumors are benign neoplasms. Myxomas are the most common benign tumor, usually originating in the left atrium.
- Clinical presentation varies depending on tumor location and can include embolic phenomena, cardiac manifestations like obstruction, or symptoms of metastatic disease. Echocardiography is the primary diagnostic tool.
- Other common benign primary tumors include papillary fibroelastomas (found on heart valves) and lipomas. Rhabdomyomas are most often seen in children with tuberous sclerosis and can cause arrhythmias
Radiological imaging of pulmonary neoplasmsPankaj Kaira
The document discusses radiological imaging of pulmonary neoplasms. It begins by noting that a wide variety of neoplasms can arise in the lungs, including both malignant and benign tumors. Bronchogenic carcinoma, specifically adenocarcinoma, squamous cell carcinoma, and small cell carcinoma, are the most common primary lung tumors. Imaging plays an important role in evaluating these tumors and detecting metastases. Common imaging findings on chest x-rays, CT scans, PET scans, and other modalities are described for different tumor types and locations within the lungs.
This document discusses pediatric abdominal tumors and provides information on evaluating and characterizing various tumors through imaging modalities like ultrasound, CT, and MRI. Key tumors mentioned include Wilm's tumor of the kidney, cystic nephroma, clear cell sarcoma, rhabdoid tumor, neuroblastoma, hepatoblastoma, hepatocellular carcinoma, lymphoma, leukemia, and rhabdomyosarcoma. Imaging findings for different tumors are outlined to help determine the tumor type and guide diagnosis and treatment.
This document summarizes the anatomy and imaging features of various adrenal gland lesions. It describes the typical appearance of the adrenal glands on CT and MRI. Common adrenal tumors like adenomas, carcinomas, pheochromocytomas, and metastases are discussed. Adenomas often appear lipid-rich on CT and demonstrate signal loss on opposed-phase MRI. Carcinomas usually appear large, inhomogeneous, and demonstrate central necrosis. Pheochromocytomas tend to be large and heterogeneous with areas of necrosis. Neuroblastomas often insinuate around vessels in children. Myelolipomas contain detectable fat. Distinguishing features between tumor types are highlighted.
The document discusses various pediatric mediastinal masses including lymphoma, thymic lesions, germ cell tumors, and neurogenic tumors. Lymphoma is one of the most common mediastinal neoplasms in children and can manifest as Hodgkin's or non-Hodgkin's disease. Other masses discussed include thymic hyperplasia, thymoma, cysts, and teratomas. Posterior mediastinal masses are often neural in origin and may be malignant neuroblastomas or benign ganglioneuromas. CT and MRI are useful in characterizing the appearance and extent of these pediatric mediastinal masses.
The document discusses various pediatric mediastinal masses including lymphoma, thymic hyperplasia, thymoma, germ cell tumors, and cysts. Hodgkin's lymphoma typically presents as a primary mediastinal lesion while non-Hodgkin's lymphoma usually manifests as generalised disease. Thymic hyperplasia appears as diffuse enlargement of the thymus on imaging. Thymoma is the most common primary tumor and appears as a well-defined anterior mediastinal mass. Teratomas often contain fat, soft tissue, and calcium. Cystic lesions include bronchogenic cysts which are usually located near the trachea or bronchi, and pericardial cysts which abut
This document discusses radiological imaging modalities for assessing salivary gland diseases. It describes several imaging techniques including ultrasound, CT, MRI, nuclear scintigraphy and their roles in evaluating patients with salivary gland symptoms. Ultrasound can assess gland vascularity and guide biopsies. CT and MRI help determine lesion extent and involvement of surrounding structures. Nuclear scintigraphy uses radioactive tracers to identify tumors. The document also discusses common benign and malignant salivary gland tumors seen on imaging, including Warthin's tumor, oncocytoma, mucoepidermoid carcinoma and adenoid cystic carcinoma. Imaging features vary depending on tumor type and grade. In summary, various radiological imaging techniques play an important role in
Imaging in small bowel tumors Dr. Muhammad Bin Zulfiqar
Here we will discuss CT and MR enterography. We will further discuss the use of negative contrast.
Four important tumors will be discussed.
1. Different types of mediastinal masses have characteristic locations and relationships to surrounding structures on imaging.
2. Anterior mediastinal masses may efface the heart border or margin of the ascending aorta. Middle mediastinal masses may splay the carina. Posterior mediastinal masses displace the paravertebral lines laterally.
3. Thymic cysts can occur within the thymus gland or following radiation therapy. On imaging they appear as large, inhomogeneous solid masses in the antero-left mediastinum without calcium or fat.
Metastases are the most common malignant liver lesions and liver imaging is often used to detect them. They can be hypovascular or hypervascular. Hypovascular metastases are best seen on portal venous phase imaging while hypervascular ones are best seen on arterial phase. Differentiating metastases from other lesions such as hemangiomas or cysts requires analyzing features like enhancement pattern and imaging characteristics on multiple sequences/phases. Multiphasic CT or MRI is often used to fully characterize lesions.
The document discusses various types of adrenal masses and how they appear on different imaging modalities like CT, MRI, and ultrasound. It describes the normal anatomy of the adrenal glands and then discusses common benign and malignant adrenal masses. Some key masses mentioned include adrenal adenomas, pheochromocytomas, adrenocortical carcinomas, myelolipomas, and neuroblastomas. Imaging features discussed help differentiate between these different adrenal lesions.
Presentation1.pptx, radiological imaging of extra nodal lymphoma.Abdellah Nazeer
This document discusses extranodal lymphoma, which refers to lymphomatous infiltration of sites other than lymph nodes. It provides examples of extranodal lymphoma in many organs and tissues throughout the body, as seen on various imaging modalities like CT, MRI, PET, and ultrasound. Extranodal lymphoma can mimic other diseases, so it should be considered in the differential diagnosis of mass lesions and focal abnormalities. Biopsy is often needed for definitive diagnosis.
Radioanatomy of mediastinum and approach to mediastinal massesAkankshaMalviya3
The document discusses the anatomy, divisions, and contents of the mediastinum. It describes approaches to evaluating mediastinal masses through investigations such as chest x-rays, CT, MRI, and biopsy. Differential diagnoses are provided for masses in various mediastinal compartments, including the anterior mediastinum where the five most common masses are thymoma, thyroid masses, lymphoma, teratomas, and aortic aneurysms. Evaluation of mediastinal masses involves determining the location and narrowing the differential diagnosis through imaging studies and biopsy.
This document discusses various types of intraventricular lesions that can be seen on different imaging modalities like CT and MRI. It describes the typical appearance and characteristics of common intraventricular masses like choroid plexus papilloma, astrocytoma, subependymal giant cell astrocytoma, ependymoma, meningioma, metastases and others. It also discusses vascular malformations, cysts and other rare lesions that can involve the lateral, third or fourth ventricles. Imaging findings for each type of lesion are provided along with examples of relevant images.
This document discusses primary retroperitoneal neoplasms, which arise outside of major retroperitoneal organs. It notes that 70-80% of retroperitoneal masses are malignant in nature. The document then categorizes and describes several specific types of solid neoplastic masses that can occur in the retroperitoneum, including mesodermal neoplasms (such as liposarcomas and leiomyosarcomas), neurogenic tumors, and others. For each type of mass, it provides details on prevalence, appearance on CT and MRI scans, characteristics, associated syndromes, and other relevant clinical information.
The document discusses the anatomy and disorders of the mediastinum. It begins by describing the anatomy of the different compartments of the mediastinum and structures contained within each. It then discusses various disorders that can arise in each compartment, including tumors, cysts, infections and others. Common tumors mentioned are thymoma, teratomas, and lymphomas. Clinical features, investigations, treatment and prognosis of different disorders are provided.
The document discusses various primary retroperitoneal neoplasms. It describes the location of the retroperitoneum and divides primary retroperitoneal neoplasms into solid neoplastic masses including mesodermal neoplasms (such as liposarcomas, leiomyosarcomas, and malignant fibrous histiocytomas), neurogenic tumors, and germ cell/sex cord/stromal tumors. For each type of neoplasm, it provides details on characteristics such as common subtypes, demographic and imaging appearances, and clinical implications.
This document discusses the diagnostic workup for mediastinal tumors. It begins by describing the different types of tumors that can occur in the anterior, middle, and posterior mediastinum. Signs and symptoms are non-specific but may include cough, chest pain, and weight loss. Chest x-ray is often the initial test, while CT scan provides more detail on location and tissue characteristics. MRI and nuclear imaging can further characterize masses. Tissue sampling methods include needle biopsy, mediastinoscopy, and thoracoscopy. Surgical procedures like mediastinotomy or thoracotomy may be needed in some cases. Laboratory tests help identify certain tumor types. A multidisciplinary approach is typically needed for diagnosis and treatment planning of
radio anatomy of meidastinum and approach to mediastinal masses.pptxsurekhanitave5
This document provides an overview of mediastinal anatomy and masses. It discusses the divisions and contents of the mediastinum, as well as approaches to evaluating mediastinal masses. Common masses are described for each mediastinal compartment, including anterior mediastinal masses like thymoma, thyroid masses, and germ cell tumors. Middle mediastinal masses include lymphadenopathy, lymphoma, sarcoidosis, and cysts. Investigations for characterizing mediastinal masses include chest x-ray, CT, MRI, and tissue biopsy. Localization clues on chest x-ray and characteristics on imaging are outlined for different mediastinal structures and masses.
This document describes two cases:
1. Autoimmune pancreatitis, which is a unique form of pancreatitis caused by autoimmune disease. It commonly affects men aged 40-65 and presents with obstructive jaundice and abdominal pain. Imaging shows swelling of the pancreas and narrowing of the pancreatic and bile ducts. Treatment involves steroids.
2. Chordoma, a rare bone tumor originating from embryonic remnants. It most commonly affects the sacrum and skull base. Imaging shows a destructive lytic bone lesion and soft tissue mass. It is locally aggressive but slow growing. Treatment involves surgery and radiation therapy.
The document discusses various imaging modalities used to evaluate peripheral arterial disease (PAD), including duplex ultrasonography, ankle brachial pressure index (ABPI) measurements, digital subtraction angiography (DSA), computed tomography angiography (CTA), and magnetic resonance angiography (MRA). DSA is considered the gold standard but is invasive, while CTA and MRA provide non-invasive alternatives but have limitations such as exposure to radiation or contrast dye. Ultrasonography is useful first-line but not adequate for surgical planning. Overall, the optimal imaging choice depends on each patient's clinical situation and risk factors.
This document discusses cranio-vertebral anomalies and their classification. It begins by classifying bony and soft tissue anomalies. It then discusses the ossification centers of various bones including the occiput, atlas, and axis. Next, it covers the anatomical landmarks and radiological lines used to evaluate the cranio-vertebral junction, such as Chamberlain's line, McGregor's line, and the basilar angle. It provides the normal measurements for these lines. The document concludes by discussing radiological evaluation techniques including CT and MRI measurements.
The document discusses the embryogenesis and development of the gastrointestinal tract. It begins by describing how the endoderm-lined yolk sac is incorporated into the embryo to form the primitive gut during folding of the embryo. It then describes the specific regions of the gut - the pharyngeal gut, foregut, midgut and hindgut. It notes that the endoderm forms the gut lining and associated glands while mesoderm forms the muscle, connective tissue and peritoneal components. The mesentery is also described. Common causes of gastrointestinal obstruction by age are listed. The document then focuses specifically on the development and common abnormalities of the esophagus.
The bone scan is a nuclear medicine procedure that uses radiopharmaceuticals like technetium-99m to generate images of the skeletal system. It is useful for evaluating bone disorders and can detect abnormalities earlier than other imaging modalities. The scan involves injection of the radiotracer and acquisition of blood flow, blood pool, and bone scan phase images over hours. It is helpful for detecting fractures, metastases, infections and other bone abnormalities. Precise diagnosis may require correlation with clinical history and other imaging tests.
This document discusses imaging of prostate cancer. It begins with an introduction to prostate cancer epidemiology and symptoms. Transrectal ultrasound is described as the primary imaging method for diagnosis and staging, allowing visualization of the prostate zones and measurement of volume. Appearances of normal variants, benign conditions like BPH and prostatitis, and prostate cancer on ultrasound are presented. The role of MRI in accurate staging of extracapsular extension and seminal vesicle invasion is also summarized.
Amol toxic and metabolic encephalopathy syndromeAmol Gulhane
This document discusses various toxic and metabolic encephalopathies and their imaging findings on MRI. It describes conditions such as hyperammonemic encephalopathy, hepatic encephalopathy, osmotic myelinolysis, metronidazole induced encephalopathy, alcoholic encephalopathy, Wernicke's encephalopathy, hypoglycemic encephalopathy, and posterior reversible encephalopathy syndrome. For each condition, it provides details on clinical presentation, characteristic imaging patterns on different MRI sequences, and important differential diagnoses.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
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There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
2. •Prevalence of 0.002-0.3%
• About 75 percent of all primary cardiac tumors -
benign neoplasms.
•Remaining 25 percent of primary cardiac tumors -
malignant neoplasms-metastatic MC
Metastatic involvement of the heart is 30 times more
prevalent than primary cardiac tumors.
3. Presurgical assessment of malignant cardiac tumors
with the use of MDCT and MRI allow determination of
the resectability of tumors and planning for the
reconstruction of cardiac chambers.
Echocardiography is the best imaging modality
to depict small masses that arise from the
cardiac valves.
4. Visualization of extracardiac extension is suboptimal with the
use of transthoracic echocardiography for the evaluation of
malignant cardiac masses.
TEE overcomes the limited acoustic window of the
transthoracic mode, the airways and lungs can be obstacles
for imaging of the aortic arch, pulmonary arteries and some
systemic and pulmonary veins
5. MRI is presently the modality of choice to evaluate cardiac tumors.
High contrast resolution and multiplanar capability allow a specific
diagnosis and optimal evaluation of myocardial infiltration,
pericardial involvement and extracardiac extension.
The use of ECG-gated MDCT has better soft tissue contrast than
echocardiography and can definitively characterize fatty content
and calcifications.
8. BENIGN TUMORS
Myxomas
Myxomas are the most common benign tumor found in adults(4th -7th
decades).
classic triad of symptoms - cardiac obstructive symptoms related to
the obstruction of blood flow , embolic events, and constitutional
symptoms such as fever, malaise and weight loss.
It ocurs in the middle age, 40-70 years, and has an
association with pituitary adenoma, testicular tumours and
Cushing's disease.
9. • Majority sporadic; some are familial
(autosomal dominant transmission) or part
of a syndrome
1. Carney complex – spotty skin pigmentation,
myxomas, endocrine overactivity,
schwannomas
2. NAME syndrome – nevi, atrial myxoma,
myxoid neurofibroma, ephelides
3. LAMB syndrome – lentigines, atrial myxoma,
blue nevi
10. Sporadic Familial or Syndrome Myxoma
• Solitary
• More common
• Usually located in left atria
• Arise from inter-atrial septum
in vicinity of fossa ovalis
• May also occur in the
ventricles or multiple locations
• Younger individual
• Often multiple location
• Less common (10%)
• Autosomal dominant pattern
of transmission
• Associated with freckling, non-
cardiac tumors, endocrine
neoplasms
• Recurrent after surgery
11. Thromboembolic events-- left-sided myxomas
brain, kidney, spleen and extremities
right-sided myxomas lung .
75% of myxomas == left atrium, in the interatrial
septum in the region of the fossa ovalis;
20% of myxomas == right atrium, rarely found in
the ventricles.
12. The plain film appearances can vary from a normal examination
to an enlarged heart with selective left atrial and left atria
appendage enlargement
Some mxyoma tend to Calcify with associated movement
detected on fluoroscopy.
Non Contrast-enhanced CT -- a well-defined spherical or ovoid
intracavitary mass, which typically has lobular contours.
Tumor attenuation is lower than that of the unopacified blood.
13. On intravenous contrast it appears as a mass of
low attenuation surrounded by enhancing
intracardiac blood.
Heterogeneity is a common feature of myxomas
-reflects hemorrhage, necrosis, cyst formation,
fibrosis or calcification.
14. MRI
MRI appearances are heterogeneous, reflecting the non-uniformity of
these masses. They are typically spherical or ovoid masses which may
be sessile or pedunculated
T1 : tend to be low to intermediate signal, but areas of haemorrhage
may be high
T2 : hyperintense
can be variable due to heterogeneity in tumour componants
; e.g calcific components, hemosiderin > low signal ; myxomatous
components > high signal
GE (gradient echo) : may show blooming of calcific components
T1 C+ (Gd) : shows enhancement (important discriminator from a
thrombus)
15. Imaging findings:
A transthoracic echocardiographic study, subcostal 4 chamber view
shows a mobile mass in the right atrium . The mass is highly
echogenic and appears to protrude through the tricuspid valve into the
right ventricle The interatrial septum appears normal
MDCT confirms the presence of a large RA mass .On the axial MDCT
images a large lobulated tumor mass is seen in the right atrium.
16. Cardiac magnetic resonance (CMR) shows a mass with a broad-based
attachment to the inter-atrial septum at the floor of the fossa ovalis. The mass
has high signal intensity on T2-weighted spin echo images , persisting on fat
suppression imaging, excluding a lipoma or liposarcoma.
Signal intensity doubled on first-pass perfusion, excluding thrombus.
Delayed enhancement imaging revealed patchy hyperenhancement suggestive
of cystic cavitation, features all strongly suggestive of a myxoma.
18. Right ventricular myxoma in 30-year-old female.
A. Sagittal double inversion-recovery MR image demonstrates isointense mass
(arrow) occupying right ventricular outflow tract.
B. Sagittal triple inversion-recovery image demonstrates bright signal intensity in
most parts of mass (arrow).
C. Postcontrast double inversion-recovery image demonstrates hyperenhancement
of mass (arrow).
19. Lipomas
Second most common benign cardiac tumors
encountered in adults
Cardiac lipomas are usually solitary
and may occur in the myocardial tissue, usually
in a subepicardial location.
CT shows cardiac lipomas as homogeneous,
low-attenuation masses either in a cardiac
chamber or in the pericardial space
20. • If subepicardial
Compression of the heart
Pericardial effusion
• If subendocardial
With intracavitary extension, may
produce symptoms characteristic of their
location
• Most common chambers affected: LV, RA,
IAS
21. MR homogeneous increased signal intensity
seen on the T1- and T2-weighted ; suppressed
on fat saturated sequences.
As with soft-tissue lipomas, cardiac lipomas do
not show enhancement with the administration
of a contrast material.
22. Right atrial lipoma
A. MDCT image shows homogeneously
low-attenuated mass with pedicle (arrow)
attached to free wall of right atrium
23. High-signal-intensity mass
(L) in the lateral wall of the
right atrium. High signal
intensity on T1 imaging is
strongly suggestive of fatty
tissue and identifies this
mass as a lipoma.
24. Papillary Fibroelastomas
rare lesion, usually affecting older adults
Benign endocardial papillomas that mainly affect the cardiac
valves and account for approximately 75% of all cardiac
valvular tumors
It is composed of multiple papillary fronds, which predispose
it to form thrombi.
Because of the risk of lethal
embolization to the coronary or cerebral circulation, surgical
resection is the treatment of choice.
25. Papillary fibroelastomas are usually not observed on CT
or MR images as they are small (< 1.5 cm in diameter)
and are attached to the moving valves .
MR imaging typically demonstrates the presence of a
mass on a valve leaflet or on the endocardial surface .
These tumors can create turbulence in the blood flow,
which might be demonstrated with the use of cine MR
imaging
26. Papillary fibroelastoma of aortic valve in 60-year-
old female
A. ECG-gated multidetector CT image
demonstrates abnormal thickening of aortic valve
(arrow).
B, C. Oblique cine MR images demonstrates small mass (arrows) attached to aortic
valve that was moving according to valvular motion.
D. Oblique transverse triple inversion-recovery MR image demonstrates slightly high
signal intensity of small mass (arrow).
27. Rhabdomyomas
most common cardiac tumors in infancy and childhood
often associated with tuberous sclerosis in up to 50% of
cases
Most patients are asymptomatic, and rhabdomyomas
generally regress spontaneously.
tumors originate within the myocardium, typically in the
ventricles, and multiple lesions present in up to 90% of
cases
28. Echocardiography is usually used for evaluation
of these tumors.
On noncontrast-enhanced CT scans,
rhabdomyomas are typically denser than the adjacent
myocardium
and may have areas of fat density.
Enhances on contrast CT.
MR isointense to marginally hyperintense as
compared with the myocardium on T1-weighted
images and hyperintense on T2-weighted images
29. Cardiac rhabdomyoma in newborn with tuberous sclerosis
B. Sagittal T1-weighted spin echo MR image shows isointense mass (arrows) in
septum and anterior wall of left ventricle.
C. Transverse gadolinium-enhanced T1-weighted spin echo MR image shows
mild enhancement of mass (arrows).
30. Fibromas
mainly affect infants and children, second most common tumors found
in this age group
Grossly, the lesions are solid tumors that arise within the myocardium
and can grow to a size that obliterates the cavity.
CT homogeneous masses with soft-tissue attenuation, may be either
sharply marginated or infiltrative. Calcification is often observed.
MRhomogeneously isointense to hypointense relative to the
myocardium on T1- and T2-weighted images due to a dense, fibrous
nature. For the same reason, these tumors often show delayed
enhancement on gadolinium-enhanced study
31. Left ventricular fibroma
A. ECG-gated multidetector CT image shows
myocardial thickening (arrows) and spotty
calcification (arrowhead) in lateral wall of left
ventricle.
B. Transverse double inversion-recovery MR
image shows hypointense mass (arrows) in
myocardium of left ventricle.
C. Transverse triple inversion-recovery MR
image also shows hypointense mass (arrows)
in myocardium of left ventricle.
D. Delayed MR image with suppression of normal myocardial signal 10 minutes
after administration of gadolinium demonstrates hyperenhancement of mass
32. Hemangiomas
benign vascular tumors
5-10% of benign tumors
Cardiac hemangiomas are heterogeneous on precontrast CT images
and show intense contrast enhancement
As with hepatic hemangiomas, these tumors typically show
intermediate signal intensity on T1-weighted images and
hyperintense on the T2-weighted images
33. Cavernous hemangioma of left atrial appendage
A. Transverse double inversionrecovery MR image
shows intermediate signal intensity mass (arrows) in
left atrial appendage.
B. Transverse triple inversion-recovery MR image
shows hyperintense mass (arrows) with smooth
margin.
C. Coronal gadolinium-enhanced double inversion-
recovery MR image shows strong enhancement of
lesion (arrows).
34. PRIMARY MALIGNANCIES
Angiosarcomas
most common cardiac sarcomas
Adults. M>F
the tumors tend to occur in the right atrium and involve the
pericardium.
usually cause right-sided heart failure or tamponade
Presentation is late, and there is often the presence of metastases at
the time of diagnosis, particularly to the lung.
Invasive behavior is a feature of malignant lesions with pericardial or
pleural effusion.
35. CT low-attenuation mass in the right atrium, might be irregular or
nodular
Heterogenous enhancement
Cardiac sarcomas heterogeneous signal intensity on MR images ,
with blood-filled spaces within the neoplasm seen on T2 as high signal
intensity
A papillary appearance can be observed as a specific MR feature of an
angiosarcoma, with a nodular area of high signal intensity interspersed
within areas of intermediate signal intensity seen on T1- and T2-
weighted images
In cases with diffuse pericardial infiltration, linear enhancement along
the vascular spaces seen ( "sunray" appearance )
36. D. Gadolinium-enhanced double inversion-recovery MR image shows
heterogeneous hyperenhancement of mass. Within mass, some portions (arrows)
have no enhancement, representing intratumoral thrombosis.
Angiosarcoma of right atrium in 48-year-old male.
A. ECG-gated multidetector CT image shows large mass
(arrows) in free wall of right atrium. Mass shows irregular
and nodular contour and strong contrast enhancement.
B. Transverse double inversion-recovery MR image
demonstrates mostly isointense mass (arrows) in right
atrium. C. Transverse triple inversion-recovery MR
image demonstrates presence of heterogeneously
hyperintense mass (arrows).
37. Other Cardiac Sarcomas
angiosarcomas most common cardiac sarcomas,
undifferentiated sarcomas
malignant fibrous histiocytomas (MFHs),
Leiomyosarcomas
Osteosarcomas
Lymphosarcomas
myxosarcomas,
neurogenic sarcomas
synovial sarcomas
neurofibrosarcomas
Kaposi's sarcomas can affect the heart.
Angiosarcomas -- right atrium
other sarcomas-- left atrium
38. MFHs left atrium , attached to the posterior wall
MFH -- nonspecific signal intensity MRI
A MFH arises from the posterior wall of the left atrium and can extend
into the pulmonary veins
Myxoma does not extent to PV
MFH
39. Malignant fibrous histiocytoma in 57-year-old female.
A. Transverse double inversion-recovery MR image
shows large isointense mass (arrows) arising from
posterior wall of left atrium that extends into mitral
valve.
B. Transverse triple inversion-recovery MR image
shows hyperintense mass (arrows) with irregular
contour.
C. Gadolinium-enhanced double inversion-recovery
MR image shows heterogeneous hyperenhancement
of mass (arrows).
D. MDCT reformatted image shows that mitral valve (arrow) is abutting mass
.
40. Primary cardiac osteosarcomas
usually arise from the posterior wall of the
left atrium near the pulmonary veins.
metastatic osteosarcomas,usually involve the right
atrium.
May calcify and may be confused with calcifi ed myxoma.
OSlocation in the posterior wall of the left atrium
myxomas septal location
42. Lymphoma
Up to 25% of patients with lymphoma have cardiac involvement
at autopsy
Primary cardiac lymphoma (lymphoma limited to the heart and/or
pericardium) is very rare.
Primary cardiac lymphoma is usually a B-cell lymphoma.
most common locationright heart, usually the right atrium
Associated pericardial effusion is common
43. Primary cardiac lymphoma
Contrast-enhanced CT shows a lobulated mass
within the right heart at the level of the tricuspid valve. The mass
extends into the right atrial and right ventricular cavities
44. MR image shows a tumoral mass of a
cardiac lymphoma that affects the anterior
right atrial and ventricular wall and spreads
to the pericardium at the heart's apex.
45. Secondary Cardiac Tumors
Metastatic cardiac involvement is much more common
than primary cardiac neoplasms,
2ry occur most frequently in patients with pleural
mesothelioma , melanoma ,lung adenocarcinoma ,
undifferentiated carcinomas , lung squamous cell
carcinoma and breast carcinoma
Direct extension of tumor is the most
common route and typically occurs
in lung and breast cancers.
46. Symptoms due to pericardial involvement.
RCC, adrenal carcinoma, HCC, and uterine leiomyosarcoma may
involve
the heart by extension through the IVC.
Thyroid carcinoma
may extend into the heart through the SVC.
Lung cancer
may also spread along the pulmonary veins to involve the
left atrium.
47. Both lymphangitic and hematogenous
route
Leukemia and lymphoma are
the most common tumors to cause cardiac
metastases by the lymphangitic route, in
which case mediastinal nodes are
invariably involved.
48. Lesions That Mimic Cardiac Tumors
Thrombus
Thrombus within the heart may mimic a cardiac mass.
In the atria, thrombus usually involves the appendages
In the ventricle, thrombus usually occurs over an area of
hypokinesis such as a myocardial infarction or within a
ventricular aneurysm.
49. Lipomatous Hypertrophy of the Interatrial
Septum
Fat may be detected in the AV grooves and the interatrial
septum.
Normally, fat in the interatrial septum measures
less than 1 cm anterior and posterior to the fossa ovalis.
LHIS results in increased fat deposition in the interatrial
septum.
This may mimic an atrial tumor on an echocardiogram
Typically, the lesion is dumbbell-shaped
because of the sparing of the region of the fossa ovalis
50. CT and MRI are able to accurately
depict the fatty nature of the lesion
Pathologically, the lesion is not a true encapsulated
Lipoma . fetal or brown fat intermixed with myocardial cells.
Treatment is directed at controlling the
arrhythmia, if present.
51. Normal Anatomic Structures
Normal anatomic structures that may be mistaken for a
mass include
a prominent moderator band in the right ventricle,
52.
53. The crista terminalis is a vertically
orientated smooth muscle ridge extending
from the SVC to the IVC.
its size and shape can be variable and it
may protrude into the RA, it may be
mistaken as an intracardiac mass or
thrombus.
Prominent crista terminalis
55. The RAA has a triangular or pyramidal
shape with a wide base opening and rough
trabeculation of pectinate muscles.
The pectinate muscle in the RAA may be
misinterpreted as a mass or thrombus.
the pectinate muscle have parallel course
on imaging