Differential diagnosis of cardiac mass: Thrombi? Or Tumor?

Abstract

Diagnostic imaging plays an important role in diagnoses of intracardiac masses and determining therapeutic strategies. Preoperative biopsy tissue diagnosis using forceps for intracardiac masses is contraindicated due to the risk of embolism. As such, the therapeutic strategy (surgery, thrombolytic therapy, or follow-up) is basically determined based on image diagnosis. On the other hand, the heart is a perpetually moving organ. There is a limit in evaluating the morphology and mobility of a moving intracardiac mass using CT or MRI with the limited frame rates. Therefore, noninvasive echocardiography with excellent temporal resolution plays a central role in diagnosing intracardiac masses and deciding therapeutic strategies. Furthermore, there are various types of tumors or masses found in the heart, such as thrombus, infectious vegetations, and benign or malignant tumors. In order to select the appropriate therapeutic strategy, physicians and sonographers who perform echocardiography need to be familiar with the basic differentiation points of these structures. This review briefly provides the basics of how to make a differential diagnosis of intracardiac mass by echocardiography.