Book contents
- Frontmatter
- Contents
- List of contributors
- Preface
- Section 1 Cardiac pseudotumors and other challenging diagnoses
- Case 1 Right atrial pseudotumor due to crista terminalis
- Case 2 Cardiac pseudotumor due to lipomatous hypertrophy of the interatrial septum
- Case 3 Cardiac pseudotumor due to caseous mitral annular calcification
- Case 4 Cardiac pseudotumor due to focal hypertrophic cardiomyopathy
- Case 5 Pseudothrombus in the left ventricle due to microvascular obstruction
- Case 6 Pseudothrombus in the left atrial appendage
- Case 7 Pseudolymphadenopathy due to fluid in the pericardial recess
- Case 8 Valvular masses
- Case 9 Cardiac angiosarcoma
- Case 10 Ventricular non-compaction
- Case 11 Hypertrophic cardiomyopathy mimics
- Case 12 Stress cardiomyopathy
- Case 13 Epipericardial fat necrosis
- Section 2 Cardiac aneurysms and diverticula
- Section 3 Anatomic variants and congenital lesions
- Section 4 Coronary arteries
- Section 5 Pulmonary arteries
- Section 6 Cardiovascular MRI artifacts
- Section 7 Acute aorta and aortic aneurysms
- Section 8 Post-operative aorta
- Section 9 Mesenteric vascular
- Section 10 Peripheral vascular
- Section 11 Veins
- Index
- References
Case 8 - Valvular masses
from Section 1 - Cardiac pseudotumors and other challenging diagnoses
Published online by Cambridge University Press: 05 June 2015
- Frontmatter
- Contents
- List of contributors
- Preface
- Section 1 Cardiac pseudotumors and other challenging diagnoses
- Case 1 Right atrial pseudotumor due to crista terminalis
- Case 2 Cardiac pseudotumor due to lipomatous hypertrophy of the interatrial septum
- Case 3 Cardiac pseudotumor due to caseous mitral annular calcification
- Case 4 Cardiac pseudotumor due to focal hypertrophic cardiomyopathy
- Case 5 Pseudothrombus in the left ventricle due to microvascular obstruction
- Case 6 Pseudothrombus in the left atrial appendage
- Case 7 Pseudolymphadenopathy due to fluid in the pericardial recess
- Case 8 Valvular masses
- Case 9 Cardiac angiosarcoma
- Case 10 Ventricular non-compaction
- Case 11 Hypertrophic cardiomyopathy mimics
- Case 12 Stress cardiomyopathy
- Case 13 Epipericardial fat necrosis
- Section 2 Cardiac aneurysms and diverticula
- Section 3 Anatomic variants and congenital lesions
- Section 4 Coronary arteries
- Section 5 Pulmonary arteries
- Section 6 Cardiovascular MRI artifacts
- Section 7 Acute aorta and aortic aneurysms
- Section 8 Post-operative aorta
- Section 9 Mesenteric vascular
- Section 10 Peripheral vascular
- Section 11 Veins
- Index
- References
Summary
Imaging description
Valvular masses can be challenging when encountered on cardiac CT or MRI. Echocardiography is the test of choice for evaluation of the valves; however, in some patients, CT or MRI may be requested due to lack of adequate imaging windows or need to evaluate for associated complications. Vegetations in the setting of infective endocarditis are more common than valvular tumors, are mobile during the cardiac cycle, low attenuation on CT (Figure 8.1), and low signal intensity on T1- and T2-weighted MRI. They are associated with valvular thickening or other sequelae of infectious endocarditis such as valvular regurgitation, perforation (Figure 8.1), fistulas between cardiac chambers, paravalvular abscesses, and pseudoaneurysms. Primary tumors of the valve are rare. Of these, the most commonly encountered valvular tumor is a papillary fibroelastoma which is commonly round with an irregular, frond-like surface. It will be low in attenuation on CT images (Figure 8.2), similar to the valve tissue, and will have intermediate T1 and high T2 signal intensity on MRI with homogenous delayed enhancement (Figure 8.3). Papillary fibroelastomas are usually mobile on a stalk, moving with the valve leaflets through the cardiac cycle. Involvement of the aortic and mitral valve is more common than the tricuspid and pulmonic valve.
Importance
Although rare, valvular masses are important to recognize at cardiac imaging due to the fact that they pose a risk of distal embolization. In patients with infective endocarditis, neurologic complications develop in 20–40%. Although benign, the treatment of choice for valvular tumors is surgical resection to avoid these complications. Antibiotic therapy may be used to treat vegetations; however, in complicated cases, such as those with fistulas or abscesses, surgical valve replacement may be necessary.
Typical clinical scenario
Valvular masses may be encountered incidentally or may be referred to advanced imaging after discovery at echocardiography. Coronary CT angiography may be used to preoperatively evaluate the coronary arteries in patients who are planned for valve replacement.
- Type
- Chapter
- Information
- Pearls and Pitfalls in Cardiovascular ImagingPseudolesions, Artifacts, and Other Difficult Diagnoses, pp. 26 - 29Publisher: Cambridge University PressPrint publication year: 2015