Myxomas are cardiac neoplasms that are most commonly located in the left atrium, usually arising from the vicinity of the fossa ovalis. However, there have been cases, although very rarely, of valvular myxoma. A cardiac mass found incidentally on echocardiography can present a challenge in particular if asymptomatic or found in an unusual location. We present the case of a 58-year-old male with kidney disease treated with chronic dialysis, referred to the cardiology clinic because of an incidental finding of a mitral valvular mass on routine transthoracic echocardiography. Although this lesion was initially misdiagnosed as native valvular endocarditis with vegetation, a series of clinical and radiological investigations led to the preoperative diagnosis of possible papillary fibroelastoma or calcified thrombotic mass. Given the increased risk of embolization due to the mass being mobile and greater than 1 cm in size, the patient was referred to cardiac surgery. Excision of the mass without mitral valve replacement was performed. Histopathological findings of the mass revealed the existence of a cardiac myxoma. In such cases of a mitral valve mass, multimodality imaging should have of high priority to achieve an accurate diagnosis. Although a definitive diagnosis can only be established after surgical excision of the mass and histopathological confirmation, it is very important to consider a differential diagnosis of mitral valve myxoma in any patient with an unexplained mitral valve mass.

The echocardiography is the first-line imaging modality in detecting the cardiac lipoma. Contrast-enhanced echocardiography improves its structural definition and characteristics of blood supply to exclude thrombus and malignant tumors.

We introduced a case that large cardiac mass involving nearly the whole left ventricular cavity and papillary muscles without any complications. Multimodal imaging has confirmed lipoma before surgery. However, rather than recommending conservative treatment in accordance with guidelines, surgical intervention was performed to prevent future hemodynamic abnormalities.

Combined with multimodal imaging, we showed a rare case on comprehensive evaluation of left ventricular silent lipoma and provided new clues for surgical strategy, which were different from guideline recommendations.

Cardiac tumors, though rare, present significant diagnostic and therapeutic challenges due to their diverse nature and potential severity. These tumors, which can be primary or metastatic, are often detected incidentally through imaging modalities such as echocardiography or CT scans. Differentiating between benign and malignant forms is crucial for guiding appropriate management strategies. This review synthesizes current diagnostic approaches and treatment modalities for cardiac tumors, with a focus on the role of imaging techniques like UCG, CT, MRI, and PET in tumor characterization. Multidisciplinary treatment plans are necessary, including surgical resection for benign tumors, chemotherapy, and radiotherapy for malignant tumors, and novel targeted therapies such as MDM2 inhibitors for selected cases. While primary malignant tumors like sarcomas and mesotheliomas exhibit rapid progression and poor prognosis, recent advances in multimodal therapy offer potential improvements in survival. The incidence of primary cardiac tumors is low, with an autopsy-reported occurrence rate of 0.02%. Benign cardiac tumors, such as myxomas and fibromas, generally have favorable outcomes with surgical resection. In contrast, primary malignant tumors like sarcomas and mesotheliomas exhibit rapid progression and poor prognosis, necessitating aggressive treatment including surgery, chemotherapy, and radiotherapy. Metastatic cardiac tumors occur in approximately 10% of cancer patients at autopsy and are managed according to the treatment plan for the primary malignancy. The management of cardiac tumors requires a multidisciplinary approach tailored to tumor type, location, and systemic effects. While benign tumors often respond well to surgical management, malignant and metastatic tumors demand more complex strategies to optimize patient outcomes.

We report a case of a giant left ventricular rhabdomyoma in a 6-month-old male, which was undetected during prenatal screening but was identified postnatally through routine echocardiography and subsequently surgically resected. This article highlights the importance of regular prenatal screening and follow-up, with particular emphasis on the value of high-resolution fetal echocardiography between 28 and 32 weeks of gestation, even without initial indications of structural heart abnormalities.

This trial aimed to investigate the safety and efficacy of treating malignant cardiac tumors with hypofractionated radiation therapy and concurrent chemotherapy (hypo-CCRT) using a 1.5T MR-Linac.

Patients with both primary and secondary malignant cardiac tumors underwent split-course hypo-CCRT on a 1.5T MR-Linac, receiving 30 Gy/6 fractions initially, followed by a boost course of 20 to 30 Gy/4 to 6 fractions, totaling 50 to 60 Gy. Concurrent chemotherapy (docetaxel and nedaplatin) was administered weekly. The primary endpoint was local recurrence-free survival (LRFS). Secondary endpoints included objective response rate, progression-free survival (PFS), overall survival (OS), toxicity, and quality of life.

From October 2021 to October 2023, 7 patients were enrolled in the study and received split-course hypo-CCRT on the 1.5T MR-Linac. The median follow-up was 26 months (range, 8.3-36.3 months). The objective response rate was 85.7% (6/7). The 2-year LRFS rate was 71.4%, with the median LRFS not reached. The 2-year PFS rate was 38.1%, with a median PFS of 20.1 months (95% CI, 8.8-31.5 months). The 2-year OS rate was 71.4%, with the median OS yet to be determined. No patients experienced acute or late toxicity above grade 2. Three months posttreatment, the ejection fraction percentage increased from 63.43% ± 7.21% to 68.57% ± 4.28% (P = .02), and the internal diameter of the right ventricle decreased from 24.43 ± 2.99 to 18.86 ± 3.13 mm (P < .01). The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 scores were significantly improved at 6 months posttreatment (P < .05).

Split-course hypo-CCRT on MR-Linac for malignant cardiac tumors was feasible, generally well-tolerated, and showed promising oncologic as well as patient-reported outcomes in this small prospective cohort. Further study is warranted for the long-term effects.

Differentiating cardiac tumors is crucial for treatment planning, but the specificity of echocardiography as a first-line screening tool is limited. This study aimed to develop a streamlined classification model for cardiac tumors in cancer patients using echocardiographic data.

A total of 215 echocardiographic clips representing cardiac tumors from 121 patients with extracardiac malignancies were selected and divided into training and testing cohorts. The cardiac neoplasms were classified as benign or malignant based on substantial evidence. Radiomics features were extracted utilizing PyRadiomics, and a radiomics score (Rad-score) was subsequently computed through an optimized machine learning (ML) framework tailored for tumor classification. Non-experience-dependent indicators (NDIs) derived from baseline and echocardiographic assessments were ascertained and integrated with the Rad-score to construct a classification model. A composite nomogram was developed, and its predictive accuracy was benchmarked against that of junior and senior physicians using receiver operating characteristic (ROC) curves and decision curve analysis (DCA).

Significant differences in the Rad-scores and four NDIs [age, tumor location, and long and short diameters (SDs)] (all P<0.05) distinguished benign from malignant tumors. Patients with malignant cardiac tumors were more likely to be younger, for the tumor to be in the right cardiac circulatory system, be larger in size, and have a lower Rad-score. Among these indicators, the Rad-score, tumor location, and SD were shown to be independent predictors of malignancy. The integrated model demonstrated strong classification capability [area under the curve (AUC): 0.873; 95% confidence interval (CI): 0.820-0.914], which was substantiated in the test cohort (AUC: 0.861; 95% CI: 0.807-0.904). The classification performance of the generated nomogram was comparable to that of the senior doctor (AUC: 0.867 vs. 0.873, DeLong P=0.928) and surpassed that of the junior doctor (AUC: 0.867 vs. 0.669, DeLong P=0.029). DCA indicated that the nomogram was superior to the junior physician for classification tasks.

This study developed a nomogram that involved radiomics and objective indicators based on echocardiography to effectively distinguish between malignant and benign cardiac tumors, thereby improving classification practices and decision-making in diverse clinical settings.

The aim of the study is to assess the efficacy of computed tomography (CT) and positron emission tomography (PET)/CT findings in differentiating between cardiac sarcoma and cardiac hematologic neoplasms, which are rare but potentially lethal primary cardiac malignancies.

We searched the electronic medical record for pathology-proven cases from 2012 to 2023, finding 69 patients (46 sarcomas, 23 cardiac hematologic neoplasms). Imaging features including tumor size, atrioventricular (AV) groove involvement, right coronary artery (RCA) encasement by 180°, pericardial effusion, lymphadenopathy, and metabolic activity on fluorodeoxyglucose PET were reviewed by a radiology fellow. Statistical analysis was performed using Fisher exact test and Wilcoxon test.

Cardiac sarcoma patients were younger (median age 49 years) compared to patients with cardiac hematologic malignancies (66 years, P  = 0.006). While tumor size and chamber involvement were similar between the 2 categories, hematologic malignancies exhibited a notable predilection for AV groove involvement (70% vs 43%, P  = 0.04) and RCA encasement (52% vs 26%, P  = 0.02). Pulmonary metastases were more frequent in sarcoma cases (33% vs 4%, P  = 0.006). There was no significant difference in fluorodeoxyglucose uptake. Lymphadenopathy was similar between the 2 disease groups. A decision tree constructed using AV groove involvement and patient age achieved 75% accuracy in predicting the diagnosis of the mass.

Overall, there is a substantial overlap in imaging features of cardiac sarcomas and hematologic malignancies involving the heart. Involvement of the AV groove and RCA encasement can allow a radiologist to favor hematologic malignancy. Ultimately, biopsy is required to establish a diagnosis.

Cardiac tumours can be classified as neoplastic or non-neoplastic, with secondary tumours being significantly more common than primary ones. Among secondary tumours, melanoma has the highest propensity for cardiac involvement. Pleomorphic dermal sarcoma (PDS) is a rare skin neoplasm, with an estimated metastatic risk of 10% to 20%. This report presents the case of a 52-year-old male who, after a history of PDS, developed cardiac metastasis 4 years postexcision. Despite clear surgical margins and adjuvant radiotherapy, he later exhibited metastatic disease affecting the lungs and heart. Advanced imaging revealed tumour invasion into the left atrium, leading to palliative chemotherapy and ultimately the patient's transition to palliative care 7 months after diagnosis. This case underscores the need for vigilance in monitoring potential metastasis in rare tumours like PDS.

Malignant cardiac lymphoma is rare and commonly involves nodules on the right side of the heart. We herein report a case of malignant cardiac lymphoma with diffuse extension into the left ventricle. The patient was a woman in her 60s who complained of dyspnea and malaise. Echocardiography revealed left ventricular hypertrophy (LVH), and magnetic resonance imaging revealed diffuse contrast enhancement on delayed contrast. Cardiac catheterization and a myocardial biopsy suggested heart failure due to cardiac malignant lymphoma, and diastolic dysfunction was mild despite LVH. The patient underwent chemotherapy, and her cardiac function improved and was maintained.

The differential diagnosis of cardiac myxomas (CM), the most common benign primary cardiac tumors, is broad and a thorough diagnostic workup is required to establish accurate diagnosis prior to surgical resection. Transthoracic echocardiography (TTE) is usually the first imaging modality used for diagnosis of suspected CM. In a single tertiary centre study, we sought to determine the accuracy, sensitivity, and specificity of TTE in the diagnosis of CM and to determine echocardiographic characteristics indicative of CM.

We retrospectively analyzed clinical, echocardiographic, and pathohistological findings of 73 patients consecutively admitted for suspected CM.

After diagnostic workup, 53 (73%) patients were treated surgically at our institution. Based on preoperative TTE, patients were divided into a CM group (n=45, 85%) and non-myxoma (NM) group. Of the 53 pathohistological specimens obtained during surgery, 39 (73%) were CM. The sensitivity and specificity of preoperative echocardiography were 97% and 50%, respectively. The overall accuracy was 85%. All NM tumors were found in an atypical location and 72% of CM were found in a typical position in the left atrium (p < 0.001). Tumors in NM group were significantly smaller than CM (24.3 ± 13.2 mm vs. 37.9 ± 18.3 mm, p = 0.017).

Our study confirms very good accuracy of TTE in the diagnosis of CM. The most important echocardiographic characteristics to differentiate between CM and tumors of different etiology are tumor location and size. Smaller tumors presenting at an atypical location are less likely to be diagnosed as CM, and these require additional imaging modalities for accurate diagnosis.

Lymphomas, which originate from the haematopoietic system, are seldom found in the heart due to the absence of a lymphoid system. Primary cardiac lymphoma is quite rare. Cardiac lymphomas can present with dyspnoea, heart failure, pericardial effusion, and arrhythmia. Given the high mortality rates associated with cardiac masses, swift diagnosis is crucial.

A 46-year-old male patient presented to the emergency department of our hospital with complaints of dyspnoea and palpitations. The patient's electrocardiogram revealed a tachycardia characterized by a wide QRS complex and a heart rate of 234 beats per minute, and an intravenous infusion of amiodarone was immediately started. In the cardiac MRI performed, a mass lesion was observed, which was ∼63 ∗ 30 ∗ 79 mm in size, extending from the right atrium to the superior vena cava and right atrial appendage, infiltrating the free wall of the right ventricle, pericardium, and right atrial wall, and showing distinct diffusion restriction in places. The patient's cardiac MRI was documented with a suspicion for cardiac lymphoma. The patient was referred to haematology clinic and started on rituximab-cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy.

The diagnosis of primary cardiac lymphoma is uncommon. Even a mass exceeding 7 cm in size may not be visible on transthoracic echocardiography. The use of cardiac MRI to identify intracardiac masses should be incorporated into the diagnostic process to expedite diagnosis and the initiation of life-saving treatment.

Cardiac tumours present significant clinical challenges due to their wide differential, complex anatomical and physiological implications, as well as the potential for widespread invasion in the case of malignancies. This review synthesizes recent findings surrounding the diagnosis and management of specifically right-sided cardiac tumours, with a particular focus on surgical resection and reconstructive techniques.

Management of cardiac tumours can be categorized into three key phases. First: early and accurate diagnosis is critical for improving outcomes, especially in malignancies. Advances in imaging modalities like MRI, CT, PET-CT, and biopsy techniques enhance diagnostic accuracy. Second: surgical resection is a cornerstone treatment for both benign and malignant right-sided cardiac tumours. Surgery is often curative for benign tumours, while for malignant tumours, R0 resection (complete microscopic removal) in appropriate candidates correlates with better survival. Third: managing cardiac malignancies necessitates a multidisciplinary approach, integrating additional therapies such as chemotherapy, radiation, and emerging immunotherapies tailored to patient and tumour characteristics.

Managing right-sided cardiac tumours demands interdisciplinary expertise. Standardized protocols are limited by the rarity of cases and insufficient high-quality data. International collaboration and sharing of experiences through prospective registries and clinical studies are essential to advancing knowledge and improving patient outcomes.

A 13-y-old captive female cheetah (Acinonyx jubatus) succumbed following the acute onset of respiratory distress. Autopsy revealed bacterial bronchopneumonia as the primary cause of death. Additionally, splenic myelolipomas and systemic amyloidosis were identified postmortem. Interestingly, a solitary, firm nodule was found in the right atrial wall, consisting histologically of mature adipocytes with partial osseous and cartilaginous differentiation, consistent with osteochondrolipoma. Hepatic congestion suggested right heart failure. Although the direct impact of the cardiac mass on heart function remains unclear, its potential contribution to the fatal outcome cannot be discounted. To our knowledge, cardiac osteochondrolipoma has not been reported previously in cheetahs or other animals.

This review article - which is devoted to a wide range of physicians, e.g., pathologists, clinicians, radiologists, and general practitioners - is an up-to-date clinico-pathological description of cardiac tumours. Although rare, cardiac tumours are key components in oncology practice since both their early diagnosis and appropriate management denote urgent needs. Primary cardiac tumours (PCTs) are categorized in recent WHO classifications as well as in other scientific contributions. Their incidence is around 0.02% while their prevalence is between 0.001% and 0.03%. Among PCTs, benign lesions account for 85% of cases, while malignant neoplasms for 15%. Compared to PCTs, secondary cardiac tumours are 20-30-fold more common. The most frequent PCTs in adulthood are papillary fibroelastoma and cardiac myxoma, while, in childhood, cardiac rhabdomyoma. Heart metastases may occur through direct extension, or, indirectly, via bloodstream, lymphatics or intracavitary diffusion. Thoracic cancers (e.g. from pleura, lung, breast) are the most frequent cause of cardiac metastasis followed by oesophageal and haematological malignancies. Symptoms of PCTs (e.g. arrhythmias, dyspnoea, chest discomfort, syncope) are usually the result of both their regional involvement and location. Non-invasive imaging techniques (e.g. echocardiography, MRI, CT) and biopsy are key means in delineating tumour characteristics, size, and adjacent structure involvement. Most PCTs require surgery, which is recommended to prevent life-threatening complications. While many benign cardiac neoplasms may be completely resected, the treatment of choice for malignant PCTs and metastases is a combination of surgery, radio- and/or chemotherapy, as well as new alternative treatments, which may prolong survival in a small patient subset.

Cardiac tumors (CTs), although rare, can be a significant cause of sudden cardiac death (SCD), particularly when not diagnosed early. The tumors most associated with SCD include myxomas, fibromas, rhabdomyomas, and sarcomas, which can cause fatal arrhythmias, blood flow obstruction, or embolization. Myxomas, which often develop in the left atrium, can cause valvular obstruction or cerebral emboli, while malignant tumors, such as sarcomas, can infiltrate the myocardium or conduction system, causing serious arrhythmias. Rhabdomyomas, which are common in children and associated with tuberous sclerosis, can lead to ventricular tachyarrhythmias. Early diagnosis using advanced imaging techniques such as echocardiography and magnetic resonance imaging is crucial for preventing SCD. Timely diagnosis and precise characterization of lesions can help reduce the risk of SCD, thus improving the clinical management of patients, with the aim of supporting personalized treatment and improving life prospects. In this state-of-the-art review, we analyze the association between CTs and SCD, with particular attention to the histological features of benign and malignant neoplasms. Through an updated overview of the pathological aspects, we aim to improve the understanding of these tumors and promote a more effective multidisciplinary diagnostic and therapeutic approach to prevent fatal events.

Cardiac metastases (CMs) are more common than primary cardiac tumors, with autopsy studies reporting incidence rates between 2.3% and 18.3%. Their increasing detection is largely attributed to advances in cancer treatments, which have extended patient survival. CMs may present with diverse clinical manifestations depending on their size, location, and extent of infiltration, although they often remain asymptomatic and are identified only postmortem. Sometimes, they are incidentally discovered during tumor staging or follow-up evaluations. This review explores the incidence, pathophysiology, clinical features, and potential complications of CMs, focusing on their prevalence and characteristics. It highlights the importance of early detection and optimized management strategies to address this growing clinical concern. Further research is essential to elucidate the mechanisms driving CMs and develop effective therapeutic interventions.

Cardiovascular computed tomography (CCT) is a versatile, readily available, and non-invasive imaging tool with high-resolution capabilities in many cardiovascular diseases (CVD). Our review explains the increased risk of CVD among patients with cancer due to chemoradiotherapies, shared risk factors and cancer itself and explores the expanding role of CCT in the detection, surveillance, and management of numerous CVD among these patients.

Recent research has highlighted the versatility and enhanced resolution capabilities of CCT in assessing a wide range of cardiovascular diseases. Early detection of cardiac changes and monitoring of disease progression in asymptomatic patients with cancer may lessen the severity of CVD. It offers an essential means to assess for coronary artery disease when patients are either unable to safely undergo stress testing for ischemia evaluation or at risk of complications from invasive coronary angiography. Furthermore, CCT extends its utility to valvular diseases, cardiomyopathies, pericardial diseases, cardiac masses, and radiation-induced cardiovascular diseases, allowing for a comprehensive, noninvasive assessment of the entire spectrum of cancer treatment associated CVD. Looking to the future, the integration of artificial intelligence and machine learning algorithms holds potential for automated image interpretation, improved precision and earlier detection of subclinical cardiac deterioration, allowing opportunities for earlier intervention and disease prevention. CCT is a useful imaging modality for assessing the myriad cardiovascular manifestations of diseases such as coronary artery disease, cardiomyopathies, pericardial disesaes, cardiac masses and radiation-induced cardiovascular diseases. CCT has several advantages. Readily available non-cardiac chest CT scans of patients with cancer may help with improved cardiovascular care, enhanced ASCVD risk stratification and toxicity surveillance.

Cardiac magnetic resonance (CMR) is established as a key imaging modality in a wide range of cardiovascular diseases and has an emerging diagnostic and prognostic role in selected patients presenting acutely. Recent technical advancements have improved the versatility of this imaging technique, which has become quicker and more detailed in both functional and tissue characterization assessments. Information derived from this test has the potential to change clinical management, guide therapeutic decisions, and provide risk stratification. This review aims to highlight the evolving diagnostic and prognostic role of CMR in this setting, whilst also providing practical guidance on which patients can benefit the most from CMR and which information can be derived from this test that will impact clinical management.

Cardiac masses present a considerable diagnostic challenge because of their diverse causes and potential clinical implications. Traditional imaging methods, such as transthoracic echocardiography and transesophageal echocardiography, are crucial for initial assessments owing to their accessibility, but they have a major limitation represented by inter-operator variability. Therefore, cardiac computed tomography (CT) has become an indispensable adjunct, providing detailed anatomical information and tissue characterization. This review examines the prevalence, categorization and diagnostic benefits of cardiac CT in the evaluation of cardiac masses. The high-resolution imaging and multiplanar features of cardiac CT allow in-depth assessment of the structure, location and enhancement patterns of masses, helping to distinguish benign from malignant masses and guide clinical decision-making. Specific imaging features of benign and malignant tumors, as well as non-neoplastic masses, are discussed, highlighting the role of CT in overall cardiac assessment. This article highlights the importance of CT in surgical preparation, risk assessment and ongoing monitoring, and highlights its effect on improving patients' outcomes. With continued advances in CT technology, the integration of this modality into routine clinical practice should improve the accuracy of diagnosis and management of cardiac masses, strengthening the essential role of cardiac CT as a vital component of contemporary cardiovascular imaging.

Patients with acute pulmonary embolism (PE) have a wide spectrum of clinical presentations, from incidental findings to sudden cardiac death. Management and treatment recommendations in currently available guidelines vary according to patient risk and haemodynamic profile. A clot-in-transit (CiT) in the right heart chambers may be occasionally identified and is, therefore, an under-recognised but challenging condition, often preceding an abrupt clinical deterioration, and associated with increased mortality. Data on the detection of a CiT are sparse but consistent in attributing negative prognostic relevance, and therefore the presence of CiT should be systematically investigated and recorded in the setting of PE.In this review, the challenges related to the identification of a CiT are highlighted. Here, we propose an algorithm where the role of the Pulmonary Embolism Response Team (PERT) is reinforced. The PERT should convene once the CiT is suspected, to define the timeline for the diagnostic steps and subsequent management on a case-by-case basis. A patient with PE and CiT requires close bedside monitoring and rapid escalation therapy in case of clinical deterioration. Beyond anticoagulation alone, more aggressive strategies can be considered, including systemic thrombolysis, surgical pulmonary embolectomy and the currently emerging catheter-directed therapies. PROSPERO registration number: CRD42024493303.

In this study, we present the case of a 38-year-old woman who was diagnosed with primary cardiac undifferentiated sarcoma after hospital admission. Following postoperative treatment that included radiotherapy and immunotherapy, the patient developed esophagus stenosis.

Echinococcosis is a zoonotic parasitic disease prevalent in pastoral areas, mainly involving the liver and lungs, and rarely affecting the brain and heart. This article describes the diagnosis and treatment of 14 patients with cardiac encapsulated cysts, with the aim of providing insights into the clinical presentation, diagnostic challenges, therapeutic strategies, and outcomes associated with cardiac encapsulated cysts.

This retrospective case series included 13 patients with cardiac and/or cerebral encapsulated cysts.

We retrospectively analyzed 14 patients diagnosed with cardiac and pericardial echinococcosis between 2012 and 2024 at our hospital. The patients' average age was 26 years, ranging from 3 to 60 years. Echinococcal cysts were found in various cardiac locations, including the pericardium (5 patients), left ventricle (3 patients), right atrium (2 patients), and apical region of the heart (1 patient). Chest pain (6 patients) was a common symptom if the cyst was in the heart, dyspnea, or cough (3 patients) if it was in the lungs, and epilepsy (1 patient) if it was in the brain. Diagnosis of this condition necessitates the performance of both laboratory tests and imaging procedures. The latter requires the expertise of a trained professional to accurately differentiate between cardiac-encapsulated cysts and other types of cysts. All patients in our study were examined as described above. The recommended course of treatment is typically surgical removal of the cyst and administration of medications to prevent recurrence. In instances where the patient declines to surgery, it is advised that they be provided with medication and scheduled for regular follow-up appointments. In our study, data were lost for two patients. Eight patients underwent open-heart surgery, one underwent craniotomy for epilepsy, one underwent thoracentesis and drainage for pleural effusion, and one patient declined surgery.

Cardiac echinococcosis is common in pastoral populations, Surgical excision combined with pharmacological treatment is the best option for the treatment of cardiac echinococcosis.

Treatment options for patients with high-risk metastatic clear cell renal cell carcinoma (mccRCC) include immune checkpoint inhibitors and tyrosine kinase inhibitors (TKIs), but clinical manifestations and treatment of these patients are rarely reported because patients with cardiac metastases and abrupt circulatory disorders are very rare and there are no precise guidelines to follow. In this study, we analyzed and discussed the clinical characteristics, related characteristics, pathogenesis and treatment strategies of patients with cardiac metastases of kidney cancer, so as to provide reference for the diagnosis and treatment of cardiac metastatic tumors.

The patient was diagnosed with renal cell carcinoma and underwent surgical radical resection, no special treatment was performed after surgery. Metastases of the right thigh muscles and both lungs were found after 4 years, and the patient was treated with 1 cycle of sunitinib + sintilimab. The patient had sudden symptoms of circulatory obstruction, computed tomography angiography (CTA) showed that the right atrial mass was occupied, and cardiac surgery was performed, and the postoperative pathology confirmed that it was kidney cancer heart metastasis, the operation was successful. The patient had aggravated lung infection after 2 weeks of follow-up, and the symptoms improved after treatment with antibiotics, anticoagulation, and nutritional support. This operation relieved the patient's circulatory embolism, saved the patient's life, and prolonged the patient's survival.

This case study highlights the rare clinical manifestations of cardiac metastasis from ccRCC. For patients who have the opportunity for surgery, surgical treatment is recommended as the preferred option. Early detection and treatment are the key to prolonging the survival of patients with cardiac metastasis from tumors.

Cardiac masses are complex clinical conditions that frequently pose diagnostic challenges in cardiology practice. These masses can form within heart chambers or near the pericardium and are generally categorized as either non-neoplastic or neoplastic. These latter are further classified into benign and malignant (primary and secondary or metastatic). Diagnosing these conditions often requires a multiparametric approach that includes both clinical features, such as the patient's and associated clinical conditions, and multimodality imaging. However, histological examination of the resected specimen is often necessary to ascertain the nature of the mass. Given their heterogeneity and the rarity of many cardiac masses, there are no guidelines or consensus on the best diagnostic approach. Modern imaging protocols must be tailored to the specific clinical issues and patient characteristics, given the rapid advancements in technology. Thus, it is imperative to use a multimodality approach, combining different imaging techniques and multidisciplinary teamwork. Hereby, we propose a practical algorithm for evaluating cardiac lesions using a step-by-step implementation of multimodal imaging. Ultimately, the goal is to tailor the most suitable imaging technique to the patient's needs.

The medico-surgical management of cardiac tumors when there is a suspicion of malignancy is complex. Moreover, in a critically ill setting, the choice of diagnostic tools seems crucial.

We present the case of a sixty-four-year-old patient with no prior medical history who was admitted to the intensive care unit with obstructive shock secondary to a right heart mass and pulmonary embolism. Clinical and biological features revealed secondary hemophagocytic lympho-histiocytosis (HLH). The patient underwent a diagnostic procedure with dual thoracoscopic and mediastinoscopy with biopsies. Following the diagnosis of primary cardiac lymphoma, the patient received sequential chemotherapy without undergoing cardiac surgery leading to initial improvement, with reductions in intracardiac obstruction and in biomarkers associated with hemophagocytic lympho-histiocytosis.

When a cardiac mass is associated with extracardiac symptoms indicative of a hematological malignancy, the preferred treatment is chemotherapy, and cardiac surgery should be avoided.

Extracavitary cardiac calcific amorphous tumors/masses are extremely rare. We present a case report of a 62-year-old man with end-stage renal disease who presented with extracavitary cardiac calcific amorphous tumors/masses compressing the biventricular outflow tracts, resulting in hemodynamic compromise and progressive limitation of activities. The patient was successfully treated with surgery, with complete resolution of symptoms and markedly improved quality of life.

Cardiac myxomas are typically treated surgically; however, the operative mortality and recurrence rates are not negligible. In the current report we describe a case of repeat percutaneous aspiration of a right atrial myxoma. The report supports feasibility of the procedure, provides the asymptomatic timeframe after debulking, and the regrowth rate.

Right atrial myxomas (RAMs) are exceedingly rare cardiac tumors that can incur devastating complications. These tumors are capable of producing right-sided heart failure (rHF) through obstruction of venous return and tricuspid inflow. Herein, we describe a 52-year-old woman presenting with classic symptomatology of rHF as clinical sequelae of a giant RAM. The clinician should be cognizant of RAMs as an atypical etiology of rHF, and the complementary imaging modalities in the diagnostic work-up and early surgical resection as key management strategies.

This case series highlights the role of endomyocardial biopsy (EMB) in diagnosing cardiac tumors instead of tumor resection. EMB provided critical diagnostic clarity and influenced therapeutic decisions, demonstrating its utility in complex cardiovascular cases while preventing unnecessary surgery. Furthermore, EMB provides vital information that can be used for a multidisciplinary approach to cardiac tumors.

Cardiac magnetic resonance (CMR) parametric mapping is underexplored in cardiac tumours. To evaluate the contribution of mapping sequences on the characterization of paediatric tumours.

All paediatric patients referred for cardiac tumours at Bambino Gesù Children's Hospital from June 2017 to November 2023, who underwent CMR with mapping sequences, were included. The diagnosis of tumour type was performed according to signal characteristics on different sequences. Mass parametric mapping for each subtype and interobserver variability was assessed. Sixteen patients were enrolled. The mean age at CMR was 7 ± 5 years. 'Traditional' mass type assessment diagnosed haemangioma (Group A) in three patients (19%), fibroma (Group B) in four patients (25%), rhabdomyoma (Group C) in six patients (37%), and lipoma (Group D) in three patients (19%). The analysis of variance analysis revealed significant differences in mass native T1 and mass extracellular volume (ECV) values among the four subgroups (P < 0.001 for both comparisons). The mean native T1 and ECV values were respectively 1465 ± 158 ms and 54 ± 4% for Group A, 860 ± 118 ms and 93 ± 4% for Group B, 1007 ± 57 ms and 23 ± 5% for Group C, and 215 ± 13 ms and 0 ± 0% for Group D.

Mass mapping analysis is feasible and reproducible in children. ECV values provide the most accurate differentiation. Mass ECV consistently resembles normal myocardium in rhabdomyoma, is extremely high (approaching 100%) in fibroma, equals to zero in lipoma, and matches blood pool ECV (1-Hct) in haemangioma.

We report the noninvasive imaging diagnosis of a massive right atrial lipoma in a young male patient. Echocardiography and myocardial contrast echocardiography were used to assess echo intensity, tumor size, anatomic boundary, hemodynamics, and contrast agent perfusion. Dual-source CT revealed that the CT value of the tumor was fat density. Cardiac MRI showed high signals of T1 and T2 weighted images, while the low signals of fat saturation sequences. Finally, the tumor was surgically resected and the diagnosis of right atrial lipoma was confirmed by pathological section. Our study indicates that multimodal imaging may facilitate a potential pathological diagnosis before biopsy and can help plan further treatment.

Pericardial and cardiac masses in patients with established malignant neoplasms represent a diagnostic and therapeutic challenge. We present the case of a 66-year-old woman with history of myxoid liposarcoma of the left thigh who had an unexpected recurrence in the pericardium 12 years later.

Cardiac myxomas are the most common primary intracardiac tumors and are histologically benign. However, they are potentially dangerous because of the risk of systemic embolism. Echocardiography is the key diagnostic tool for atrial myxomas, allowing for the identification of the tumor, as well as determining its location, shape, size, and connections with adjacent cardiac structures. Surgical resection is curative in most patients, with tumor relapse and recurrent embolism being relatively rare.

We present a case of a 76-year-old man with de novo right heart failure. Echocardiography initially detected a mass near to the posterior area of the right atrium. Despite a comprehensive multimodality imaging assessment, the exact location of the mass remained unclear. Positron emission tomography scan revealed comparable hypermetabolic activity to that of the bloodstream, suggestive of a vascular tumor. Surgical resection via right anterior mini-thoracotomy confirmed an intracardiac mass that was ultimately diagnosed as a capillary hemangioma. This case underscores the challenges in the era of advanced cardiac imaging modalities in precisely localizing and characterizing masses, particularly rare entities such as cardiac hemangiomas.

A hemangioma of the mitral valve and aortomitral curtain was incidentally discovered in an adolescent. The lesion was surgically excised, and the mitral valve was reconstructed with complete preservation of valvular function. Pertinent principles of multimodality imaging-based diagnosis and nuances of operative management of this rare, vascular tumor are discussed.

BACKGROUND Cardiac tumors are divided into 2 categories: primary, originating from the heart, and metastatic, which spread to the heart from a different location, with metastatic tumors representing the vast majority. Cardiac tumors, depending on the size and location, can predispose patients to arrhythmic or hemodynamic complications. We present a patient with a history of B-cell lymphoma (DLBCL) in remission for 3 years who developed acute onset congestive heart failure and complete heart block secondary to DLBCL invasion of the myocardium. CASE REPORT A 67-year-old female patient with a history of stage IV double-hit DLBCL in remission for 3 years presented with acute-onset heart failure. Nuclear medicine PET/CT revealed a massive poorly defined right lower anterior mediastinal mass extending into the entire cardiac base and right ventricular myocardium, with cardiophrenic and retroperitoneal adenopathy. Vital signs and laboratory test results were significant for a heart rate of 56 beats per min (bpm) and elevated brain natriuretic peptide. Electrocardiogram was significant for a complete heart block, maintained by a junctional escape rhythm. Biopsies of the mass revealed recurrence of DLBCL. The patient was treated with diuretics and later started on RICE chemotherapy. CONCLUSIONS Mediastinal DLBCL infiltrating the myocardium is aggressive and presents a treatment dilemma, as retreat of the mass from emergency chemotherapy can result in catastrophic complications. Our patient's condition, rarely described in literature, was severe blood flow obstruction and significant arrhythmia, both of which improved after only 1 cycle of chemotherapy and without need for permanent pacemaker.

Paragangliomas originating from blood vessels are exceptionally rare, presenting diagnostic challenges due to their histological resemblance to other vascular neoplasms. We present a case study of a 60-year-old woman with underlying hypertension and dyslipidemia with obesity, initially diagnosed with angiosarcoma based on imaging and histological characteristics viewed via CT-guided biopsy. Intraoperative exploration revealed a lobulated tumor located between the inferior vena cava (IVC) and aorta measuring 7 cm × 8 cm, during which the patient developed transient hemodynamic instabilities. Histopathological examination and immunohistochemical staining using neuroendocrine markers (chromogranin, synaptophysin, S-100 protein, and CD-56) later confirmed the tumor as a retroperitoneal paraganglioma. Retroperitoneal paraganglioma was initially misdiagnosed as angiosarcoma due to the overlapping imaging characteristics between the two tumors. This highlights the importance of raising suspicion on the possibility of retroperitoneal paraganglioma when imaging examination indicates angiosarcoma and to incorporate histopathological examination and immunohistochemistry in the diagnosis to avoid misdiagnosis.

Cardiac masses encompass a diverse range of benign and malignant tumors as well as pseudotumors. Accurate histologic identification is essential for guiding appropriate treatment, yet the diagnostic process remains challenging. Although biopsy is traditionally the diagnostic gold standard, its invasive nature and associated risks limit its application. A noninvasive multimodality imaging approach has recently emerged as an alternative, but standardized protocols and supporting evidence are still lacking. Echocardiography is typically the initial imaging modality, with cardiac magnetic resonance recognized as the noninvasive diagnostic gold standard. Cardiac computed tomography provides complementary data to aid in diagnosis and management, while positron emission tomography serves as a third-level imaging option. This state-of-the-art review highlights the role of current multimodality imaging techniques in diagnosing and managing cardiac masses and explores future directions for their applications.

Papillary fibroelastomas (PFEs) are rare, benign, primary cardiac tumors, typically found on the valve surfaces and more commonly on the left side of the heart, with occurrences in the right atrium even rarer. In this case, a highly mobile tumor was incidentally detected in the right atrium of an 83-year-old woman with advanced right lung cancer during preoperative transthoracic echocardiography and magnetic resonance imaging. Although the patient was asymptomatic and of advanced age, the tumor's high mobility warranted resection. Given her low surgical tolerance, simultaneous cardiac and lung surgery was deemed too risky. Therefore, we decided to prioritize right upper lobectomy for lung cancer, followed by minimally invasive cardiac surgery (MICS) for tumor resection. The postoperative course was uneventful, and pathological examination confirmed the diagnosis of a PFE. Although PFEs are benign and often asymptomatic, especially when located on the right side of the heart, they can lead to fatal complications such as acute myocardial infarction or pulmonary embolism. Therefore, early surgical resection should be considered, particularly for highly mobile tumors. In addition, resection via MICS may be an effective option, depending on the location and morphology of the tumor.

Cardiac myxoma is a common benign tumor, however, myxoma extensively distributed on the mitral valve is rare and seldom reported. A patient who presented with exertional dyspnea and chest tightness was examined by transthoracic and transesophageal echocardiography successively. Multiple neoplasms on the mitral valve with moderate mitral regurgitation were found and were further proved to be a diffuse myxoma on the mitral valve by histology. Three-dimensional transesophageal echocardiography provided a precise evaluation of the mitral valve neoplasms, contributing to clinical decision-making.