By :
Fauzi Muhammad
Cardiovascular Technologist
National Heart Institute

CARDIAC MASS
A few different pathologies may found in heart
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Vegetation
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Thrombus
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Cardiac Tumor

CARDIAC MASS
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VEGETATION
Intracardiac mass mainly attacted to heart vavle usually found in association with endocarditis .
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Mass Contain
Infective Organism
Fibrin
Platelet
Leucocyte

CARDIAC MASS
Location
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Valve
Chordae Tendinea
LVOT
Prosthetic valve
Ppm lead , catheters
Right side of IVS ( vsd )

CARDIAC MASS
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Size
Variable – Large with Fungal Infection
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Echo Examination
2 D
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Positive features
Visualized as a mobile Mass , oscillating.
Attached to valvular surface and collapsing into one of cardiac chamber during systole
Associated tissue changes - thickened , calcified
Irregular shape ,amorphous .
Low reflectance

CARDIAC MASS
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- High ecogenicity
Nonvalvular location
Smooth surface or fibrillar
Non mobile
Absence of regurgitation

CARDIAC MASS

CARDIAC MASS

CARDIAC MASS

CARDIAC MASS

CARDIAC MASS
M-Mode
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Thickened,Dense and
Irregular multiple echo line

CARDIAC MASS
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Color Doppler
To detect association valve abnormalities such as regurgitation
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Role of echo examination
To detect
To assess progresion , effect of medication
Valve complication
Ruptured , Perforation
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- Valvular regurgitation / stenosis
Abscess formation

CARDIAC MASS
THROMBUS
Blood that been converted from liquid to a solid state
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Precipitating condition
Dilated chamber and/or reduce contractility
Blood stagnation will result in thrombus formation
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Other cause
DCM
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- Post MI
Valve disease – MS
Prosthetis valve (mechanical/bio)
Arrhythmias ( Af,Flutter)

CARDIAC MASS
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Morphology
Bright , well define, possible mobile mass, attach to cardiac wall or flat thickening in cardiac wall (mural)
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Echo Examination
Usually clear, identifiable edges, the wall motion abnormal
(akinetic/ dykanetic)
If left atrium common location at posterior near LAA
Amorphous ,echogenic structures with variable shape
May be multiple and mobile .
Pw doppler to assess flow velocity within LAA < 20cm/sec increase the embolic risk .

CARDIAC MASS

CARDIAC MASS

CARDIAC MASS

CARDIAC MASS

CARDIAC MASS
Cardiac Tumor
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2 type
Benign eq: myxoma , lymphoma, Fibroma
Malignant - primary – Common sarcoma
Secondary – Metastase of other organ
Lung Ca , Renal Ca
- 80% cardiac Tumor - Benign
Myxoma
80% of cardiac tumor .
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Location
75% - LA
20% - RA
Rare at ventricle

CARDIAC MASS
Role of echo examination
-To look for : Size
Extension/and Invasion within and outside the heart
Valvular involment and competancy
Ventricular function
Pericardial effusion
2D
All 4 Chamber should be visualized
Location : Common origin from mid portion of the atrial septal atttach fosa ovale(narrow stalk)
Shape : Polypoid ,pedunculated ,round or oval ,soft surface
Size : Various
Mobility : May prolapes during diastole
Density : Echogenic and occasional calcified

CARDIAC MASS

CARDIAC MASS

CARDIAC MASS
M-Mode
Multiple echo line filling the space behind the mitral valve leaflet during diastole

Doppler
To detect any haemodynamic changes cause by obstruction of mitral flow

CARDIAC MASS

CARDIAC MASS
Summary
Echo examination gold standard to diagnose and manages patient with cardiac mass but other modality are needs to confirm the diagnosis such as :
Contrast echo ,TEE, 3D ,MRI ,CT Scan ,Lab
Ix , Clinical features .

THANK YOU..