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INTRODUCTION

Cardiac tumors can be broadly classified into those that arise primarily in the heart and those that reflect metastatic disease from a distant primary source. Primary cardiac tumors can be further divided into those that are pathologically benign and those that are malignant. Overall, primary cardiac tumors are relatively uncommon, whereas secondary involvement of the heart or pericardium occurs in as many as 20% of patients with end-stage metastatic cancer. While patients with cardiac tumors may present with a variety of symptoms, many patients are asymptomatic at the time of diagnosis as the tumor may be identified incidentally on imaging studies performed for other reasons. Such findings need to be differentiated from other cardiac masses such as vegetation, thrombus, or myocardial hypertrophy. Echocardiography is usually the initial method of evaluation of cardiac tumors; however, a variety of imaging modalities are now available and a multimodality approach is often necessary for accurate diagnosis and clarification of treatment options (Table 266-1).

TABLE 266-1Imaging Modalities and Their Utility in the Evaluation of Cardiac Tumors

PRIMARY TUMORS

Primary tumors of the heart are rare. Approximately three-quarters are histologically benign, and the majority of these tumors are myxomas. Malignant tumors, almost all of which are sarcomas, account for 25% of primary cardiac tumors. All cardiac tumors, regardless of pathologic type, have the potential to cause life-threatening complications. Many tumors are now surgically curable; thus, early diagnosis is imperative.

Clinical Presentation

Cardiac tumors may present with a wide array of cardiac and noncardiac manifestations. These manifestations, which depend in large part on the location and size of the tumor as well as its impact on surrounding cardiac structures, are often nonspecific features of more common forms of heart disease, such as chest pain, syncope, congestive heart failure (CHF), murmurs, ...

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