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Diagnostic imagings for primary cardiac fibrosarcoma
W J Shih1, S McCullough, M Smith
1Nuclear Medicine Service, Department of Veterans Affairs Medical Center, Lexington, KY 40511-1093.
Insights
Primary cardiac fibrosarcoma, a rare heart tumor, can present with widespread metastases, initially mimicking pulmonary issues. Advanced imaging like CT and echocardiography aids in differentiating it from other cardiac masses.
Area of Science:
- Cardiology
- Oncology
- Radiology
Background:
- Primary cardiac tumors are exceptionally rare.
- Primary cardiac fibrosarcoma is an even rarer subtype, often presenting with advanced disease.
Observation:
- A case of primary cardiac fibrosarcoma with widespread metastases is presented.
- Initial presentation included pulmonary metastases, with the cardiac lesion detected via bone scan, CT, and echocardiography.
- Imaging revealed cardiac masses causing outflow tract obstruction and invading the interventricular septum.
Findings:
- Autopsy confirmed a large cardiac fibrosarcoma (880g) invading the interventricular septum and ventricular cavities.
- Bone imaging localized the lesion but lacked specificity for malignancy.
- Contrast-enhanced computed tomography (CT) and echocardiography demonstrated cardiac chamber involvement and masses.
Implications:
- CT and echocardiography are crucial for characterizing cardiac masses and differentiating fibrosarcoma from benign conditions like myxoma.
- Early and accurate diagnosis of rare cardiac tumors is vital for patient management.
- Understanding the metastatic potential of primary cardiac fibrosarcoma is important for treatment strategies.
Abstract:
Primary tumors of the heart are rare; primary cardiac fibrosarcoma is even rarer. We report a patient with primary cardiac fibrosarcoma widespread metastases presenting with pulmonary metastases initially. The cardiac lesion was identified by bone-imaging localization on bone scan, by hypodense areas in the cardiac chambers of contrast computed tomography of the chest, and by protruding masses in ventricular cavities causing aortic valve outflow-tract obstruction by echocardiogram. At autopsy, a large tumor invaded the interventricular septum and both ventricular cavities of the heart (880 g in weight), and accounted for these imaging findings. While bone-agent localization in the heart does not differentiate malignant from benign conditions, computed tomography and echocardiography of the interatrial and interventricular septal, and right atrial and biventricular cavitary involvement may differentiate fibrosarcoma from myxoma.