Masses in right side of the heart: spectrum of imaging findings

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Silvia Pradella
Giulia Grazzini
Mayla Letteriello
Cristian De Amicis
Roberta Grassi
Nicola Maggialetti
Mattia Carbone
Pierpaolo Palumbo
Marina Carotti
Ernesto Di Cesare
Andrea Giovagnoni
Diletta Cozzi
Vittorio Miele


Cardiac radiology; Heart tumors; Cardiac CT; Cardiac MRI


Primary heart tumors are rare, benign tumors represent the majority of these. If a cardiac mass is found, the probability that it is a metastasis or a so-called “pseudo-mass” is extremely higher than a primary tumor. The detection of a heart mass during a transthoracic echocardiography (TE) is often unexpected. The TE assessment can be difficult, particularly if the mass is located at the level of the right chambers. Cardiac Computed Tomography (CCT) can be useful in anatomical evaluation and Cardiac Magnetic Resonance (CMR) for masses characterization as well. We provide an overview of right cardiac masses and their imaging futures.


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1. Paraskevaidis IA, Michalakeas CA, Papadopoulos CH, Anastasiou-Nana M. Cardiac tumors. ISRN Oncol 2011; 2011: 208929.
2. Robertson R. Primary cardiac tumours; surgical treatment. American journal of surgery 1957; 94: 183-93.
3. Basso C, Rizzo S, Valente M, Thiene G. Cardiac masses and tumours. Heart (British Cardiac Society) 2016; 102: 1230-45.
4. Ghadimi Mahani M, Lu JC, Rigsby CK, Krishnamurthy R, Dorfman AL, Agarwal PP. MRI of pediatric cardiac masses. AJR. American journal of roentgenology 2014; 202: 971-81.
5. Bovet P, Paccaud F. Body-mass index and mortality. Lancet (London, England) 2009; 374: 113; author reply 114.
6. Kassop D, Donovan MS, Cheezum MK, et al. Cardiac Masses on Cardiac CT: A Review. Current cardiovascular imaging reports 2014; 7: 9281.
7. Lichtenberger JP, 3rd, Reynolds DA, Keung J, Keung E, Carter BW. Metastasis to the Heart: A Radiologic Approach to Diagnosis With Pathologic Correlation. AJR. American journal of roentgenology 2016; 207: 764-772.
8. Susic L, Baraban V, Vincelj J, et al. Dilemma in clinical diagnosis of right ventricular masses. Journal of clinical ultrasound : JCU 2017; 45: 362-369.
9. Obeid AI, al Mudamgha A, Smulyan H. Diagnosis of right atrial mass lesions by transesophageal and transthoracic echocardiography. Chest 1993; 103: 1447-51.
10. Agliata G, Schicchi N, Agostini A, et al. Radiation exposure related to cardiovascular CT examination: comparison between conventional 64-MDCT and third-generation dual-source MDCT. La Radiologia medica 2019; 124: 753-761.
11. Rahouma M, Arisha MJ, Elmously A, et al. Cardiac tumors prevalence and mortality: A systematic review and meta-analysis. Int J Surg. 2020;76:178-189.
12. Agostini A, Kircher MF, Do R, et al. Magnetic Resonance Imaging of the Liver (Including Biliary Contrast Agents) Part 1: Technical Considerations and Contrast Materials. Seminars in roentgenology 2016; 51: 308-316.
13. Malik SB, Chen N, Parker RA 3rd, Hsu JY. Transthoracic Echocardiography: Pitfalls and Limitations as Delineated at Cardiac CT and MR Imaging. Radiographics. 2017;37:383-406.
14. Agostini A, Mari A, Lanza C, et al. Trends in radiation dose and image quality for pediatric patients with a multidetector CT and a third-generation dual-source dual-energy CT. La Radiologia medica 2019; 124: 745-752.
15. Díaz Angulo C, Méndez Díaz C, Rodríguez García E, Soler Fernández R, Rois Siso A, Marini Díaz M. Imaging findings in cardiac masses (Part I): study protocol and benign tumors. Radiologia. 2015;57:480-488.
16. Zhu D, Yin S, Cheng W, et al. Cardiac MRI-based multi-modality imaging in clinical decision-making: Preliminary assessment of a management algorithm for patients with suspected cardiac mass. Int J Cardiol. 2016;203:474-481
17. Rajiah P, MacNamara J, Chaturvedi A, Ashwath R, Fulton NL, Goerne H. Bands in the Heart: Multimodality Imaging Review. Radiographics. 2019;39:1238-1263.
18. Maleszewski JJ, Anavekar NS, Moynihan TJ, Klarich KW. Pathology, imaging, and treatment of cardiac tumours. Nat Rev Cardiol. 2017;14:536-549.
19. Tower-Rader A, Kwon D. Pericardial Masses, Cysts and Diverticula: A Comprehensive Review Using Multimodality Imaging. Prog Cardiovasc Dis. 2017;59:389-397.
20. Zoccali C, Rossi B, Zoccali G, et al. A new technique for biopsy of soft tissue neoplasms: a preliminary experience using MRI to evaluate bleeding. Minerva medica 2015; 106: 117-20.
21. Hong YJ, Hur J, Han K, et al. Quantitative Analysis of a Whole Cardiac Mass Using Dual-Energy Computed Tomography: Comparison with Conventional Computed Tomography and Magnetic Resonance Imaging. Sci Rep. 2018;8:15334.
22. Schiattarella GG, Cerulo G, De Pasquale V, et al. The Murine Model of Mucopolysaccharidosis IIIB Develops Cardiopathies over Time Leading to Heart Failure. PloS one 2015; 10: e0131662.
23. Tumma R, Dong W, Wang J, Litt H, Han Y. Evaluation of cardiac masses by CMR-strengths and pitfalls: a tertiary center experience. Int J Cardiovasc Imaging. 2016;32:913-920.
24. Ma G, Wang D, He Y, Zhang R, Zhou Y, Ying K. Pulmonary embolism as the initial manifestation of right atrial myxoma: A case report and review of the literature. Medicine (Baltimore). 2019;98:e18386.
26. Di Cesare E, Patriarca L, Panebianco L, et al. Coronary computed tomography angiography in the evaluation of intermediate risk asymptomatic individuals. La Radiologia medica 2018; 123: 686-694.
27. de Roos A, Higgins CB. Cardiac radiology: centenary review. Radiology. 2014; 273(2 Suppl):S142-59
28. Ren DY, Fuller ND, Gilbert SAB, Zhang Y. Cardiac Tumors: Clinical Perspective and Therapeutic Considerations. Curr Drug Targets. 2017;18:1805-1809.
29. Abbasi Tashnizi M, Soltani G, Mehrabi Bahar M, Ahmadi M, Golmakani E, Saremi E. Right Atrium Myxoma After Lung Adenocarcinoma. Iranian Red Crescent medical journal 2015; 17: e19656.
30. Motwani M, Kidambi A, Herzog BA, Uddin A, Greenwood JP, Plein S. MR imaging of cardiac tumors and masses: a review of methods and clinical applications. Radiology 2013; 268: 26-43.
31. Krumm P, Mangold S, Gatidis S, et al. Clinical use of cardiac PET/MRI: current state-of-the-art and potential future applications. Jpn J Radiol. 2018;36:313-323.
32. Zhou W, Srichai MB. Multi-modality Imaging Assessment of Pericardial Masses. Curr Cardiol Rep. 2017;19:32.
33. Schindler TH. Cardiovascular PET/MR imaging: Quo Vadis?. J Nucl Cardiol. 2017;24:1007-1018.
34. Kim J, Da Nam B, Hwang JH, et al. Primary cardiac angiosarcoma with right atrial wall rupture: A case report. Medicine (Baltimore). 2019;98:e15020.
35. Di Cesare E, Cademartiri F, Carbone I, et al. Clinical indications for the use of cardiac MRI. By the SIRM Study Group on Cardiac Imaging. La Radiologia medica 2013; 118: 752-98.
36. Rinuncini M, Zuin M, Scaranello F, et al. Differentiation of cardiac thrombus from cardiac tumor combining cardiac MRI and 18F-FDG-PET/CT Imaging. Int J Cardiol. 2016;212:94-96.
37. Yılmaz R, Demir AA, Önür İ, Yılbazbayhan D, Dursun M. Cardiac calcified amorphous tumors: CT and MRI findings. Diagn Interv Radiol. 2016;22:519-524.
38. Tarantini G, Favaretto E, Napodano M, et al. Design and methodologies of the POSTconditioning during coronary angioplasty in acute myocardial infarction (POST-AMI) trial. Cardiology 2010; 116: 110-6.
39. Liddy S, McQuade C, Walsh KP, Loo B, Buckley O. The Assessment of Cardiac Masses by Cardiac CT and CMR Including Pre-op 3D Reconstruction and Planning. Curr Cardiol Rep. 2019;21:103.
40. Scaglione M, Salvolini L, Casciani E, Giovagnoni A, Mazzei MA, Volterrani L. The many faces of aortic dissections: Beware of unusual presentations. European journal of radiology 2008; 65: 359-64.
41. Chan AT, Plodkowski AJ, Pun SC, et al. Prognostic utility of differential tissue characterization of cardiac neoplasm and thrombus via late gadolinium enhancement cardiovascular magnetic resonance among patients with advanced systemic cancer. J Cardiovasc Magn Reson. 2017;19:76.
42. Furlow B. Computed Tomography of Cardiac Malignancies. Radiol Technol. 2016;87:529CT-45CT.
43. Abrams HL. History of cardiac radiology. AJR Am J Roentgenol. 1996;167(2):431-8
44. Colin GC, Gerber BL, Amzulescu M, Bogaert J. Cardiac myxoma: a contemporary multimodality imaging review. Int J Cardiovasc Imaging. 2018;34:1789-1808.
45. Quarta G, Aquaro GD, Pedrotti P, et al. Cardiovascular magnetic resonance imaging in hypertrophic cardiomyopathy: the importance of clinical context. European heart journal cardiovascular Imaging 2018; 19: 601-610.
46. Wu CM, Bergquist PJ, Srichai MB. Multimodality Imaging in the Evaluation of Intracardiac Masses. Curr Treat Options Cardiovasc Med. 2019;21:55.
47. Ruscitti P, Cipriani P, Masedu F, et al. Increased Cardiovascular Events and Subclinical Atherosclerosis in Rheumatoid Arthritis Patients: 1 Year Prospective Single Centre Study. PloS one 2017; 12: e0170108.
48. Patel R, Lim RP, Saric M, et al. Diagnostic Performance of Cardiac Magnetic Resonance Imaging and Echocardiography in Evaluation of Cardiac and Paracardiac Masses. Am J Cardiol. 2016;117:135-140.
49. Di Cesare E, Battisti S, Di Sibio A, et al. Early assessment of sub-clinical cardiac involvement in systemic sclerosis (SSc) using delayed enhancement cardiac magnetic resonance (CE-MRI). European journal of radiology 2013; 82: e268-73.
50. Barone-Rochette G, Jankowski A, Rodiere M. Cardiac magnetic resonance imaging and cardiac computed tomography in clinical practice. Rev Med Interne. 2014;35(11):742-51
51. Glockner JF. Magnetic Resonance Imaging and Computed Tomography of Cardiac Masses and Pseudomasses in the Atrioventricular Groove. Canadian Association of Radiologists journal = Journal l’Association canadienne des radiologistes 2018; 69: 78-91.
52. Mousavi N, Cheezum MK, Aghayev A, et al. Assessment of Cardiac Masses by Cardiac Magnetic Resonance Imaging: Histological Correlation and Clinical Outcomes. Journal of the American Heart Association 2019; 8: e007829.
53. Schicchi N, Fogante M, Esposto Pirani P, et al. Third-generation dual-source dual-energy CT in pediatric congenital heart disease patients: state-of-the-art. La Radiologia medica 2019; 124: 1238-1252.
54. Agostini A, Borgheresi A, Mari A, et al. Dual-energy CT: theoretical principles and clinical applications. La Radiologia medica 2019; 124: 1281-1295.
55. Hoey E, Ganeshan A, Nader K, Randhawa K, Watkin R. Cardiac neoplasms and pseudotumors: imaging findings on multidetector CT angiography. Diagnostic and interventional radiology (Ankara, Turkey) 2012; 18: 67-77.
56. Grebenc ML, Rosado de Christenson ML, Burke AP, Green CE, Galvin JR. Primary cardiac and pericardial neoplasms: radiologic-pathologic correlation. Radiographics : a review publication of the Radiological Society of North America, Inc 2000; 20: 1073-103; quiz 1110-1, 1112.
57. Young PM, Foley TA, Araoz PA, Williamson EE. Computed Tomography Imaging of Cardiac Masses. Radiologic clinics of North America 2019; 57: 75-84.
58. Gowda RM, Khan IA, Nair CK, Mehta NJ, Vasavada BC, Sacchi TJ. Cardiac papillary fibroelastoma: a comprehensive analysis of 725 cases. American heart journal 2003; 146: 404-10.
59. Howard RA, Aldea GS, Shapira OM, Kasznica JM, Davidoff R. Papillary fibroelastoma: increasing recognition of a surgical disease. The Annals of thoracic surgery 1999; 68: 1881-5.
60. D’Souza J, Shah R, Abbass A, Burt JR, Goud A, Dahagam C. Invasive Cardiac Lipoma: a case report and review of literature. BMC cardiovascular disorders 2017; 17: 28.
61. Malik SB, Kwan D, Shah AB, Hsu JY. The right atrium: gateway to the heart--anatomic and pathologic imaging findings. Radiographics : a review publication of the Radiological Society of North America, Inc 2015; 35: 14-31.
62. Kondo T, Niida Y, Mizuguchi M, Nagasaki Y, Ueno Y, Nishimura A. Autopsy case of right ventricular rhabdomyoma in tuberous sclerosis complex. Legal medicine (Tokyo, Japan) 2019; 36: 37-40.
63. Sargar KM, Sheybani EF, Shenoy A, Aranake-Chrisinger J, Khanna G. Pediatric Fibroblastic and Myofibroblastic Tumors: A Pictorial Review. Radiographics : a review publication of the Radiological Society of North America, Inc 2016; 36: 1195-214.
64. Gravina M, Casavecchia G, Totaro A, et al. Left ventricular fibroma: what cardiac magnetic resonance imaging may add? International journal of cardiology 2014; 176: e63-5.
65. Li W, Teng P, Xu H, Ma L, Ni Y. Cardiac Hemangioma: A Comprehensive Analysis of 200 Cases. The Annals of thoracic surgery 2015; 99: 2246-52.
66. Hamidi M, Moody JS, Weigel TL, Kozak KR. Primary cardiac sarcoma. The Annals of thoracic surgery 2010; 90: 176-81.
67. Hoey ET, Shahid M, Ganeshan A, Baijal S, Simpson H, Watkin RW. MRI assessment of cardiac tumours: part 2, spectrum of appearances of histologically malignant lesions and tumour mimics. Quantitative imaging in medicine and surgery 2014; 4: 489-97.
68. Jeudy J, Kirsch J, Tavora F, et al. From the radiologic pathology archives: cardiac lymphoma: radiologic-pathologic correlation. Radiographics : a review publication of the Radiological Society of North America, Inc 2012; 32: 1369-80.
69. Goldberg AD, Blankstein R, Padera RF. Tumors metastatic to the heart. Circulation 2013; 128: 1790-4.
70. Rangel-Hernandez MA, Aranda-Fraustro A, Melendez-Ramirez G, Espinola-Zavaleta N. Misdiagnosis for right atrial mass: a case report. European heart journal. Case reports 2018; 2: yty004.
71. Bielicki G, Lukaszewski M, Kosiorowska K, Jakubaszko J, Nowicki R, Jasinski M. Lipomatous hypertrophy of the atrial septum - a benign heart anomaly causing unexpected surgical problems: a case report. BMC cardiovascular disorders 2018; 18: 152.
72. Carino D, Agostinelli A, Ricci M, Romano G, Nicolini F, Gherli T. A rare case of gint lipomatous hypertrophy of the atrial septum. Acta bio-medica : Atenei Parmensis 2018; 89: 114-116.

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