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Echocardiographic manifestations of mediastinal masses compressing or encroaching on the heart
I A D'Cruz1, N Feghali, C M Gross
1Cardiology Section, Medical College of Georgia, Augusta, USA.
Insights
Mediastinal masses can affect the heart through encroachment or compression, impacting cardiac chambers. Echocardiography, including transesophageal echocardiography (TEE), is crucial for diagnosing these masses and their cardiac effects.
Area of Science:
- Cardiology
- Medical Imaging
- Thoracic Surgery
Background:
- The heart's central thoracic position makes it vulnerable to mediastinal masses.
- Mediastinal masses can cause cardiac encroachment (distortion) or compression (hemodynamic compromise).
Purpose of the Study:
- To review the role of echocardiography in detecting and characterizing mediastinal masses affecting the heart.
- To highlight specific echocardiographic findings of anterior and posterior mediastinal masses.
- To emphasize the importance of recognizing esophageal/gastric masses as a cause of posterior mediastinal encroachment.
Main Methods:
- Review of echocardiographic (transthoracic and transesophageal) findings in patients with mediastinal masses.
- Comparison of echocardiography with CT and MRI for mediastinal mass evaluation.
- Analysis of the impact of mass location (anterior, posterior, superior) on cardiac structures.
Main Results:
- Anterior masses typically affect right heart chambers; posterior masses impact the left atrium/ventricle.
- Transesophageal echocardiography (TEE) aids in diagnosing masses obstructing major vessels (SVC, pulmonary veins).
- Esophageal/gastric masses, including hiatus hernia and carcinoma, can mimic left atrial masses on echocardiography.
Conclusions:
- Echocardiography is a valuable tool for evaluating mediastinal masses and their cardiac effects.
- TEE offers unique insights into vascular and atrial involvement by mediastinal masses.
- Awareness of atypical presentations, such as esophageal masses, is essential for accurate echocardiographic diagnosis.
Abstract:
Because of its central position within the thorax, the heart can be encroached upon by masses originating in either anterior, posterior, or superior mediastinum. A distinction may be made between (A) Encroachment: distortion or partial displacement of one or more cardiac chambers by a contiguous mediastinal mass, without adverse hemodynamic effects, and (B) Compression: resulting in clinical manifestations similar to tamponade. Transthoracic and, recently, transesophageal echocardiography have been found useful in detecting mediastinal masses, the information obtained being complementary or preliminary to more complete imaging by CT or MRI. Anterior masses tend to compress the right heart chambers; posterior masses impinge on or compress the left atrium or ventricle, particularly the former. The wide variety of echographic appearances are briefly reviewed. Recently TEE has made it possible to diagnose masses obstructing the superior vena cava or pulmonary veins. A common, though little known, type of posterior mediastinal encroachment that echocardiographers need to be aware of is that of abnormal esophageal/gastric masses including hiatus hernia and esophageal carcinoma, which have typical two-dimensional echo features and may sometimes simulate left atrial masses.