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Cardiac Tumours

Cardiac tumours are rare and most are benign. Myxomas, 90% of which occur in the left atrium, are the commonest of the benign tumours. Q

  1. Presentation
    1. Cardiac tumours present with syncopal attacks due to obstruction of flow within cardiac chambers,
    2. Valve incompetence due to impairment of valve closure,
    3. Symptoms of embolisation,
    4. Rarely arrythmia or constitutional symptoms such as fever, weight loss, finger clubbing, Raynaud’s
    5. syndrome or myalgia. 
  2. Investigation
    1. Echocardiography outilines the intracardiac disease Cardiac catheterisation is usually contraindicated because of the risk of inducing embolisation, unless coronary surgery is anticipated.
    2. CT scan will outline the extent of extracardiac disease.
    3. There is no non-invasive method of distinguishing between a benign from malignant cardiac lesion.
    4. Therefore surgical exploration is required for any symptomatic or clinically suspicious intra-cardiac mass.  
  3. Treatment and prognosis
    1. Surgical resection by open heart surgery under cardio-pulmonary bypass is curative for the majority of atrial myxomas and other benign tumours.
    2. Malignant neoplasms are rarely cured with surgery alone though patients whose tumours have been resected have a median survival of twenty-four months compared to eleven months for patients with unresectable tumours.  

Nuclear Imaging Relevant to the Mediastinum

Radiopharmaceutical, Radionuclide, or Radiochemical


Disease of Interest


131I, 123I

Retrosternal goiter, thyroid cancer

Monoclonal antibodies

111In, 99mTc

NSCLC, colon and breast cancer, prostate cancer metastases



Amine precursor uptake decarboxylation tumors: carcinoid, gastrinoma, insulinoma, small cell lung cancer, pheochromocytoma, glucagonoma, medullary thyroid carcinoma, paraganglioma



Lymphoma, NSCLC, melanoma



Medullary thyroid carcinoma, nonfunctional papillary or follicular thyroid carcinoma, Hürthle cell thyroid carcinoma, parathyroid adenoma or carcinoma



See sestamibi


131I, 123I

Pheochromocytoma, neuroblastoma; see also octreotide



General oncologic imaging, breast and colon cancer, melanoma


Ref: Schwartz's Principles of Surgery 9th Edition Ch 19

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