Pearls and Pitfalls in Cardiovascular Imaging 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 4 - Cardiac pseudotumor due to focal hypertrophic cardiomyopathy
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
Focal left ventricular hypertrophy is a variant phenotype of hypertrophic cardiomyopathy (HCM) usually described as involvement of < 2 cardiac segments. Focal HCM can have a mass-like appearance, simulating tumors (Figures 4.1 and 4.2). On cardiac MRI (CMR), mass-like HCM will generally be isointense to adjacent normal myocardium on dark blood spin echo T1- and T2-weighted images and bright blood steady-state free precession (SSFP) sequences. Occasionally, foci of an increased T2-weighted signal can be seen in hypertrophied segments on either dark blood or SSFP sequences, which will be mid-myocardial and patchy. On tagging images, displacement and deformation of tag lines will occur in both normal and hypertrophied myocardium due to myocyte contraction, although reduced contractility may be seen in thickened regions. First-pass perfusion sequences will show homogeneous signal intensity and perfusion characteristics similar to adjacent myocardium. Delayed enhancement has been reported in 45–80% of patients with HCM and usually involves the thickest myocardium. The delayed enhancement pattern is typically patchy and mid-myocardial; however, it can be transmural in advanced cases.
Importance
Focal HCM can have a mass-like appearance and irregular delayed enhancement that may lead to incorrect diagnosis of a cardiac tumor such as metastasis, lymphoma, fibroma, or rhabdomyoma. This can lead to patient anxiety, inappropriate biopsies, or even surgery.
Typical clinical scenario
HCM is the most common primary genetic disease of the heart and has a prevalence of 1:500 in the general population. In a large study of 333 individuals with HCM, 12% of patients had the focal pattern of hypertrophy. Patients with a focal pattern of HCM may be initially detected by echocardiography, which can lead to further evaluation by cardiac MRI. Patients are often asymptomatic or may have symptomatic left ventricular outflow tract obstruction due to septal wall hypertrophy and/or systolic anterior motion of the anterior mitral valve leaflets.
Differential diagnosis
The differential diagnosis includes metastatic and primary cardiac tumors.
- Type
- Chapter
- Information
- Pearls and Pitfalls in Cardiovascular ImagingPseudolesions, Artifacts, and Other Difficult Diagnoses, pp. 11 - 15Publisher: Cambridge University PressPrint publication year: 2015