E5355. Multimodality Pictorial Review of Secondary Cardiac Masses Emphasizing Metastases and Systemic Diseases
  1. Carissa Wieseler; Mayo Clinic
  2. Phillip Young; Mayo Clinic
Secondary cardiac tumors are more frequently encountered compared to primary cardiac tumors, with metastatic disease as the main contributor. Additionally, it is important to recognize systemic processes as additional causes. Secondary intracardiac masses may involve all elements of the heart, including the valves, coronary arteries, endocardium, myocardium, and pericardium.

Educational Goals / Teaching Points
Secondary cardiac tumors can be categorized into malignant etiologies like metastases or benign systemic processes. When evaluating cardiac masses, it is critical to account for patient demographics, history, clinical manifestations, and imaging characteristics. Cardiac involvement is suspected in patients with a known malignancy or systemic inflammatory disease, and new cardiovascular symptoms or signs. Advanced cross-sectional imaging with CT, MRI, and FDG-PET/CT are used in conjunction with ECG to further asses soft tissue detail, enhancement characteristics, extracardiac involvement, noninvasive coronary artery evaluation, and glucose metabolism.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
We present a multimodality pictorial review of unique scenarios of secondary cardiac masses. We highlight key imaging features of intracardiac Erdheim-Chester disease, sarcoidosis, immunoglobulin G4 (IgG4)-related disease, metastases from hepatocellular carcinoma (HCC), and melanoma on CT, MRI, and FDG-PET/CT. For example, we underscore additional vascular involvement in systemic inflammatory processes like Erdheim-Chester and IgG4-related diseases. Additionally, we present typical T1 shortening in melanoma metastasis, focal delayed myocardial enhancement correlating with FDG-uptake in cardiac sarcoidosis, and similar signal characteristics of HCC metastasis to the original tumor.

In summary, secondary cardiac masses may result from malignant processes like metastasis or benign systemic etiologies such as sarcoidosis and IgG4-related and Erdheim-Chester diseases. When evaluating cardiac masses, it is imperative to consider patient demographics, symptomology, and clinical results. If new cardiovascular symptoms arise, cardiac involvement should be suspected, and further diagnostic evaluation is recommended. Noninvasive cross-sectional imaging with CT, MRI, and PET/CT are utilized concurrently with ECG to delineate soft tissue detail, enhancement patterns, extracardiac invasion, metabolic activity, and coronary assessment. We present a cross-sectional pictorial review emphasizing metastases, intracardiac IgG4-related disease, Erdheim-Chester disease, and sarcoidosis manifesting as secondary cardiac masses.