Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content Download Section PDF + ++ Which of the following statements is correct regarding the use of TEE for the diagnosis of cardiac tumors? + It is unnecessary for prognostic reasons. + It can be obtained with a high grade of certainty with TEE. + It has an accuracy similar to that of pathologic examination. + It is a necessary part of the follow-up after starting the proper therapy. Download Section PDF + ++ Which of the following may help in identifying the type of tumor with TEE? + Age and sex + A history of nicotine abuse + A history of alcohol abuse + Hemoptysis + All of the above Download Section PDF + ++ Morphologic properties that may be helpful in the TEE diagnosis of cardiac tumors include: + Tumor location + Attachment site + Tumor size + Mobility + All of the above Download Section PDF + ++ Other morphologic properties that may be helpful in TEE diagnosis of cardiac tumors include: + Tumor disappearance with anticoagulant or antibiotic therapy + The texture of the tumor + The number of tumors + Familial occurrence + All of the above Download Section PDF + ++ Which of the following statements is correct regarding primary benign cardiac tumors? + Myxomas are most frequent, accounting for more than 60%. + Lipomas make up some 30% of benign cardiac tumors. + Rhabdomyomas are the third most frequent. + Eight percent are papillary fibroelastomas. Download Section PDF + ++ Which of the following statements is correct regarding primary benign cardiac tumors? + Lipomas are more frequent than myxomas. + Papillary fibroelastomas are more frequent than lipomas. + Rhabdomyomas are more frequent than fibroelastomas. + Other tumors such as fibromas, hemangiomas, and teratomas each account for less than 5%. Download Section PDF + ++ Which of the following statements is correct regarding primary malignant cardiac tumors? + Angiosarcoma is the most frequent. + Malignant lymphoma accounts for 7%. + Rhabdomyosarcoma accounts for 20%. + Atrioventricular nodal mesotheliomas account for less than 5%. Download Section PDF + ++ Which of the following statements best describes secondary or metastatic tumors? + Most often they are sarcomas. + Most often they are lymphomas. + They never affect the pericardium. + They may be of any type of tumor. Download Section PDF + ++ Which of the following best describes cardiac myxoma? + It accounts for more than 60% of primary benign cardiac tumors. + It has a male preponderance. + It occurs most often in the third through sixth decades of life. + It occurs sporadically half the time. Download Section PDF + ++ Which of the following statements is correct regarding familial cardiac myxoma? + It occurs at older ages. + It is never multiple. + It occurs more frequently in atypical locations. + It is linked to multiple endocrine neoplasia syndrome. Download Section PDF + ++ Which of the following statements best describes the location of classical myxoma? + It is most often in the left atrium. + It is in the right atrium in 30% of cases. + It is right ventricular in 10%. + It is left ventricular in 10% of cases. + All of the above statements are correct. Download Section PDF + ++ Correct statements regarding the typical morphologic characteristics of cardiac myxomas include: + The absence of calcifications + A homogeneous texture + A broad attachment to the interatrial septum + A polypoid form Download Section PDF + ++ All the following statements concerning the morphologic properties of cardiac myxomas are correct EXCEPT: + They are pedunculated. + They are friable. + They are lobulated. + They have a ragged, irregular surface. Download Section PDF + ++ Which of the following statements regarding patients with familial myxoma is correct? + They may have a variety of features called syndrome myxoma or Carney syndrome. + They may have spotty pigmentation, pigmented nevi, or both. + They may have endocrine hyperactivity such as Cushing syndrome. + They may have multiple cerebral fusiform aneurysms. + All of the above statements are correct. Download Section PDF + ++ Syndromes associated with atrial myxomas include: + NAME syndrome + Noonan syndrome + Wermer syndrome (MEN type 1) + Osler-Weber-Rendu syndrome + All of the above Download Section PDF + ++ Correct statements regarding cardiac myxomas include: + They are never found in the left atrial appendage. + They never contain channels. + They do not show areas of hemorrhage. + They can have a heterogeneous appearance caused by cystic areas. Download Section PDF + ++ Which of the following statements is correct regarding multiple myxomas? + They do not occur in the left atrium. + They are never bilateral. + They are never found simultaneously in the atrium and ventricle. + They occur more frequently in children. Download Section PDF + ++ Which of the following statements is correct regarding familial myxomas? + They may have an autosomal dominant transmission. + They have a female preponderance. + They are seldom bilateral. + They occur at older age. Download Section PDF + ++ Which of the following statements is correct regarding familial myxomas? + They are characterized by a low recurrence rate. + A careful search for multiple locations is not important. + If multiple myxomas are found in a patient, screening of first-degree relatives is indicated. + Myxomas found in young patients are more often of familial origin. Download Section PDF + ++ Typical clinical symptoms of myxoma include: + Embolization + Signs of pulmonary hypertension + Fever + Signs of pericarditis Download Section PDF + ++ Embolic symptoms of myxoma may cause: + Upper limb ischemia + Acute coronary events + Neurologic deficit + Lower limb ischemia + All of the above Download Section PDF + ++ Correct features of LAMB syndrome include: + Lentigines, atrial myxoma, and blue nevi + Lung AVMs, muscle dystrophy, and blue nevi + Lentigines, atrial myxoma, blurred vision + None of the above Download Section PDF + ++ All the following statement regarding obstruction by cardiac tumors are correct EXCEPT: + It can involve the mitral or tricuspid valve. + It can involve the aortic or pulmonic valve. + It can involve the caval or pulmonary veins. + It can cause a typical tumor “plop” after the first heart sound on auscultation if the atrioventricular valves are involved. Download Section PDF + ++ Constitutional symptoms related to cardiac myxomas include: + Arterial desaturation in the upright position + Dyspnea + Angina pectoris + Position-related palpitations + All of the above Download Section PDF + ++ Which of the following conditions is associated with cardiac myxomas? + Ischemic cardiomypathy + Dressler syndrome + Sudden death + Pleurodynia Download Section PDF + ++ Which of the following statements is true regarding the utility of intravenous ultrasound contrast agents in the evaluation of cardiac masses? + Contrast agents should be administered intravenously at a declining rate. + Malignancies appear hypoenhanced. + Myxomas appear hyperenhanced. + The use of contrast agents can potentially avoid unnecessary diagnostic surgery or inappropriate anticoagulation. Download Section PDF + ++ Compared with left atrial myxomas, right atrial myxomas: + Have a narrow attachment + Are the most common site of attachment is the posterior atrial wall + Tend to be less solid + Can be attached to the tricuspid or eustachian valve Download Section PDF + ++ Which of the following statements is correct regarding cardiac myxomas? + They may pass through the foramen ovale. + They occur at older age if they are located in the left ventricle. + They have a male preponderance if they are located in the left ventricle. + They may cause pulmonary embolism if they have a left ventricular location. Download Section PDF + ++ Which of the following statements is correct regarding cardiac rhabdomyoma? + It is the most frequent tumor in infants and children. + It is always solitary. + It most often involves the left ventricular myocardium. + It may involve mitral or tricuspid valve leaflets. Download Section PDF + ++ Which of the following statements is correct regarding cardiac rhabdomyoma? + It may project into the ventricular cavity. + It may obstruct right ventricular outflow. + It can be diagnosed before birth with fetal echocardiography. + It may regress spontaneously after birth. + All of above statements are correct. Download Section PDF + ++ Which of the following characteristics of fibromas is correct? + Originate from epicardial connective tissue + Always calcified + Typical tumors of the fifth to sixth decades of life + Ventricular intramural tumors Download Section PDF + ++ Which of the following statements is correct concerning papillary fibroelastomas? + They commonly arise from the cardiac valves. + They arise more frequently from the ventricular endocardium. + They occur most often in patients younger than 50 years. + They are frequently associated with thromboembolism. Download Section PDF + ++ Which of the following statements is correct concerning papillary fibroelastomas? + They originate from the ventricular side of the atrioventricular valves. + They originate from either side of the semilunar valves. + They occur on the aortic valve cusps in 67.5% of cases. + They occur on the mitral leaflets in 67.5% of cases. Download Section PDF + ++ All of the following are locations for papillary fibroelastomas EXCEPT: + The ventricular septum + Close to the left ventricular outflow tract + The junction between inferior vena cava and right atrium + The right side of the heart Download Section PDF + ++ Papillary fibroelastomas: + May cause angina and infarction by coronary ostial occlusion. + May cause angina and infarction by embolism. + May cause systemic embolism. + May have to be surgically resected because of the embolic risk. + All of the above statements are correct. Download Section PDF + ++ Papillary fibroelastomas: + May be multiple in 70% of cases + Have a long pedicle with single papillary fronds + Must be differentiated from Lambl excrescences + Must be differentiated from cardiac rhabdomyoma Download Section PDF + ++ The histogenesis of papillary fibroelastoma: + Is neoplastic according to most investigators + May be similar to that of cardiac rhabdomyoma + May be bacteria induced + May be induced by mycoplasma Download Section PDF + ++ In contrast to papillary fibroelastoma, Lambl's excrescences: + Are rheumatic in origin + Arise from the aortic or pulmonary arterial side of the semilunar valves along the coaptation line + May be caused by exuberant organization of thrombi + Are less mobile Download Section PDF + ++ Lipomas: + Are localized tumors limited to the heart + May cause pericardial effusion + Are large, diffuse, and not well delineated if they are intramyocardial + May arise from the pulmonary and aortic valves Download Section PDF + ++ Malignant primary cardiac tumors: + Most frequently are rhabdomyosarcomas + Include liposarcomas, fibrosarcomas, or malignant lymphomas + Are almost never sarcomas + Never cause obstruction and peripheral embolism Download Section PDF + ++ Angiosarcomas: + Are the most frequent cardiac sarcomas + Most often affect the right ventricle + Show a female preponderance + Grow partially intracavitary but never cause valvular obstruction Download Section PDF + ++ Rhabdomyosarcomas: + Have no predilection for one or another cardiac chamber + Show female preponderance + Are frequently single + Almost never cause valvular obstruction Download Section PDF + ++ Primary pericardial tumors: + Most often are fibrosarcomas + Most often are pericardial cysts + Most often are mesotheliomas + In children are most frequently lymphomas Download Section PDF + ++ Pericardial cysts: + Are benign + Occur most often in infants and children + Are more frequent in men + Are the second most frequent pericardial tumors Download Section PDF + ++ Pericardial cysts: + Are frequently located in the left costophrenic angle + Appear as solid structures on TEE + Can cause valvular obstruction + May compress a cardiac chamber Download Section PDF + ++ Which of following statements is correct regarding teratomas? + They show a male preponderance. + They are frequent in old age. + They receive their blood supply from coronary arteries. + They have an extracardiac but intrapericardial location. Download Section PDF + ++ Which of following statements is correct regarding teratomas? + They have been diagnosed by fetal echocardiography. + They manifest most often as recurrent nonbloody pericardial effusions. + They may contain hair or teeth. + They may compromise cardiac function by compression due to considerable expansion. + All of the above statements are correct. Download Section PDF + ++ Which of the following statements regarding mesotheliomas is correct? + They are benign pericardial tumors. + They may cause constrictive pericardial disease. + They affect males and females with the same frequency. + They occur with the highest incidence in the fifth to seventh decades of life. Download Section PDF + ++ The following statement regarding secondary tumors of the heart is true: + Sarcomas are more frequent than carcinomas. + They more often affect people older than 50 years. + They do not cause arrhythmias if the myocardium is involved. + They occur in more than 70% of patients with malignant melanoma. Download Section PDF + ++ Which of the following statements is correct regarding cardiac metastases? + They may involve the pericardium, myocardium, endocardium, valves, and coronary arteries. + They may cause aortic dissection. + They may cause restrictive cardiomyopathy. + They are found in more than 30% of patients with primary tumors. Download Section PDF + ++ Angina or myocardial infarction in patients with cardiac metastases: + Can be due to coronary artery spasm + Can result from concomitant atherosclerosis or fibrosis aggravated by radiation therapy + Can be caused by secretion of active products such as serotonin and bradykinin + Is the most frequent first clinical sign of these metastases Download Section PDF + ++ Direct tumor extension into the heart: + May occur along the superior vena cava. + Presents as an endocardial mass. + Is frequent with renal cell carcinoma, hepatocellular carcinoma, and primary leiomyosarcoma of the uterus. + May cause mitral valve obstruction. + All of the above statements are correct. Download Section PDF + ++ Which of the following statements is correct concerning pericardial constrictive signs in patients with cardiac metastases? + They have to be differentiated from right atrial or tricuspid valve obstruction. + They are never caused by previous radiotherapy. + They are characterized by systolic collapse of right atrium and ventricle, inferior caval vein collapse, and blunted expiratory response. + They cannot be differentiated from obstructive mechanisms on TEE. Download Section PDF + ++ Which of the following statements is correct regarding carcinoid tumors? + They belong to the group of primary cardiac tumors. + They are never secondary cardiac tumors. + They are typically located in the left ventricular wall. + They secrete active products such as serotonin and bradykinin. Download Section PDF + ++ Typical echocardiographic signs of carcinoid heart disease include: + Signs of constrictive cardiomyopathy caused by endocardial involvement + Frequent involvement of the left heart + Billowing tricuspid valve leaflets + Right ventricular volume overload Download Section PDF + ++ Which of the following statements is correct regarding carcinoid heart disease? + Bronchial tumors are prone to carcinoid disease of the right heart. + Gastrointestinal tumors cause carcinoid disease of the right heart. + The left heart is affected more frequently than the right heart. + It causes deposits on mitral and aortic valves and on the left atrial and ventricular endocardium. Download Section PDF + ++ Typical echocardiographic features of carcinoid heart disease include: + A flail tricuspid valve + Systolic doming of the tricuspid valve + Tricuspid insufficiency on color-flow mapping in most patients + Pulmonary valve abnormalities, predominantly stenosis, in most patients Download Section PDF + ++ The differential diagnosis of intracardiac masses includes: + Primary and secondary cardiac tumors + Intracardiac thrombi + Endocarditis with vegetations + Normal cardiac structures + All of the above Download Section PDF + ++ All the following are predisposing factors for left atrial thrombi except: + Atrial fibrillation + Right atrial enlargement + Rheumatic mitral stenosis + Prosthetic valve endocarditis Download Section PDF + ++ Predisposing factors for right atrial thrombi include: + The presence of an LVAD + The presence of a central venous catheter + The presence of an ASD + Female sex Download Section PDF + ++ Which of the following characteristics is correct regarding cardiac vegetations? + Homogeneous + Regularly shaped + Almost always calcified + Mobile and prone to embolization Download Section PDF + ++ Morphologic aspects of atrial thrombi that may help to differentiate them from other cardiac tumors include: + Attachment to the posterior atrial wall + Appearance as mobile, serpiginous, and coiled masses + Attachment to inferior or lateral ventricular wall + No increase in size with anticoagulant therapy Download Section PDF + ++ TEE examination prior to cardioversion: + Is optional + Is always indicated immediately after cardioversion + Does not help to prevent thromboembolic complications + Is indicated in patients with chronic atrial fibrillation with recently initiated anticoagulant therapy Download Section PDF + ++ Which of the following statements is correct regarding ventricular thrombi? + They occur in patients with large myocardial infarction. + They occur in patients with restrictive cardiomyopathy. + They occur most often in the base of the heart. + They always appear as laminar structures adhering to the ventricular wall. Download Section PDF + ++ Which of the following statements is correct regarding ventricular thrombi ? + They are most often multiple. + They are never pedunculated with a narrow stalk. + They are always laminar. + They are often homogeneous but also may be cavitary and heterogeneous. Download Section PDF + ++ Which of the following TEE findings may increase the risk for embolization of ventricular thrombi? + Shaggy, irregular borders + Mobility + Coexistence of dilated cardiomyopathy or ventricular aneurysm + Apical location + All of the above findings Download Section PDF + ++ Which of the following statements is correct regarding an atrial septal aneurysm? + It is a normal cardiac structure. + It may have to be differentiated from a cardiac tumor. + It occurs in 5% of adults. + It is frequently associated with ventricular septal defects. + All of the above statements are correct. Download Section PDF + ++ Correct statements regarding an atrial septal aneurysm include: + Frequent association with multiple atrial septal defects or mitral valve prolapse. + Phasic right-to-left excursions during the cardiac cycle of less than 1.5 cm. + Undetectable flow in the aneurysmal pocket. + Aneurysmal bulging of the interatrial septum protruding greater than 1.5 cm beyond the level of the interatrial septum. + All of the above statements are correct. Download Section PDF + ++ Which of the following statements is correct regarding an atrial septal aneurysm? + It causes morbidity and mortality via thromboembolic mechanisms. + It can be detected and differentiated on TEE with high sensitivity. + It can be nicely documented on an M-mode echocardiogram. + It can be filled with thrombus. + All of the above statements are correct. Download Section PDF + ++ Which of the following morphologic characteristics is typical for vegetations and helps differentiating vegetations from thrombi? + Coexistence of a decreased ventricular function + Movement independent of valvular structures in the cardiac phase + Association with valvular regurgitation + Attachment to the downstream side of atrioventricular or semilunar valves + All of the above Download Section PDF + ++ Which of the following statements is correct regarding the diagnosis of endocarditis? + TEE and TTE are equally valuable. + TEE is not accurate in describing late complications. + TEE is very accurate in monitoring therapy with antibiotics. + Repeat TEE has no proven benefit.