Pericardial Masses, tumors, and Congenital Absence U1 L4

Can primary pericardial tumors and masses be benign or malignant?

They may be benign or malignant

What percentage of pericardial tumors are malignant?

35%

List the 5 examples of primary pericardial tumors and masses.

1. Pericardial cysts

2. Teratomas

3. Pericardial lipoma

4. Mesothelioma

5. Angiosarcoma

What type of pericardial mass is a pericardial cyst?

A benign pericardial mass.

List the 5 possible complications of a pericardial cyst.

1. Infection

2. Hemorrhage

3. Rupture

4. Erosion into adjacent structures

5. Compression of adjacent structures

How does a pericardial cyst usually form?

From a defect in embryologic development of the pericardium.

What is the typical structure and content of a pericardial cyst?

It is typically unilocular and filled with serous fluid

What is the typical size of a pericardial cyst?

Usually 1–5 cm in diameter, but it may be larger

What is the echo appearance of a pericardial cyst?

Rounded and anechoic, typically located adjacent to the right atrium.

Are secondary metastatic pericardial tumors more or less common than primary cardiac tumors?

They are more common

List the 5 malignancies that may cause secondary metastatic pericardial tumors.

1. Sarcoma

2. Melanoma

3. Breast malignancy

4. Lung malignancy

5. Lymphoma

What is the echo appearance of a secondary metastatic pericardial tumor?

An echogenic structure with no distinct border located on the pericardial surface.

Are secondary metastatic pericardial tumors usually single or multiple?

They are usually multiple.

List the 3 findings associated with secondary metastatic pericardial tumors.

• Pericardial effusion

• Constriction

• Invasion of the pericardium by tumor

How common is congenital absence of the pericardium?

It is a very rare congenital disease.

Is congenital absence of the pericardium more common in males or females?

Males, approximately 4 times more common

What fetal-development abnormality can cause congenital absence of the pericardium?

Premature atrophy of the left common cardiac vein, causing hypoperfusion of the pericardium and agenesis.

Can absence of the pericardium be partial or complete?

Yes. It may be partial or complete

What is the most common type of congenital absence of the pericardium?

Absence of the left side.

List the 3 less common types of congenital absence of the pericardium.

• Total absence

• Right-sided absence

• Diaphragmatic absence

List the 4 cardiac defects associated with congenital absence of the pericardium.

1. ASD

2. Bicuspid aortic valve

3. PDA

4. Tetralogy of Fallot

List the 3 systemic conditions associated with congenital absence of the pericardium.

1. Diaphragmatic hernia

2. Bronchogenic cysts

3. Marfan syndrome

Can congenital absence of the pericardium be asymptomatic?

yes

List the 3 symptoms that may occur while the patient is in the left lateral decubitus position.

• Chest pain

• Dyspnea

• Palpitations

What conduction abnormality may occur with congenital absence of the pericardium?

RBBB

What is the “Snoopy sign” in congenital absence of the pericardium?

Levoposition of the heart.

List the 3 diagnostic imaging findings of congenital absence of the pericardium.

• Levoposition of the heart — Snoopy sign

• Elongated LV silhouette

• Interposed lung tissue

What serious complication can occur with partial absence of the pericardium?

Cardiac strangulation or herniation.

What happens to the echo windows and cardiac chamber position with congenital absence of the pericardium?

There may be unusual echo windows with a shift of the cardiac chambers to the left.

How does overall cardiac motion appear with congenital absence of the pericardium?

Exaggerated cardiac motion

What happens to the position of the heart when the patient changes position?

The heart shifts with patient positioning.

What septal-motion finding may be seen with congenital absence of the pericardium?

Abnormal septal motion.

What LV posterior-wall motion finding may be seen?

Vigorous LV posterior-wall motion

What systolic displacement of the LV may occur?

Anterior systolic displacement of the LV.

What treatment is needed for complete congenital absence of the pericardium?

No therapy.

How is partial congenital absence of the pericardium treated?

Surgery to avoid strangulation.

Where is epicardial fat typically located?

Anteriorly

What is the echo appearance of epicardial fat?

Hypoechoic and speckled in appearance.