**1. Introduction**

152 Echocardiography – In Specific Diseases

Pannaraj, P, Turner, C, Bastian, J & Burns, J. (2004) Failure to diagnose Kawasaki disease at the extremes of the pediatric age range. *Pediatr Infect Dis J.* Aug;23(8):789 Park, Y, Han, J, Hong, Y, Ma, J & Cha, S et al. (2011) Epidemiological features of Kawasaki

Ravekes, W, Colan, S, Gauvreau, K, Baker, A & Sundel, R et al. (2001) Aortic root dilation in

Royle, J, Williams, K, Elliott, E, Sholler, G & Nolan, T et al. (1998) Kawasaki disease in

Suzuki, A, Yamagishi, M, Kimura, K, Sugiyama, H & Arakaki, Y et al. (1996) Functional

Taubert, K, Rowley, A & Shulman, S. (1991) Nationwide survey of Kawasaki disease and

Uehara, R, Yashiro, M, Nakamura, Y & Yanagawa, H. (2003) Kawasaki disease in parents

Yeu, B, Menahem, S, Goldstein, J. (2008) Giant coronary artery aneurysms in Kawasaki disease – the need for coronary artery bypass. *Heart Lung Circ*. Oct;17(5):404-6 Yim, D, Ramsay, J, Kothari, D & Burgner, D et al. (2010) Coronary artery dilatation in toxic

Yutani, C, Go, S, Kamiya, T, Hirose, O & Misawa, H. (1981) Cardiac biopsy of Kawasaki

shock-like syndrome: the Kawasaki disease shock syndrome. *Pediatr Cardiol*

patients with Kawasaki syndrome. *Circulation*. Feb;75(2):387-94

behavior and morphology of the coronary artery wall in patients with Kawasaki disease assessed by intravascular ultrasound. *J Am Coll Cardiol.* Feb;27(2):291-6 Takahashi, M, Mason, W & Lewis, A. (1987) Regression of coronary artery aneurysms in

disease in Korea, 2006-2008. *Pediatr Int.* Feb;53(1):36-9

Kawasaki disease. *Am J Cardiol*. 87: 919–922

acute rheumatic fever. *J Pediatr*. 119: 279–282

and children. *Acta Paediatr.* Jun;92(6):694-7

disease. *Arch Pathol Lab Med.* Sep;105(9):470-3

Nov;31(8):1232-5

Australia, 1993-95. *Arch Dis Child.* Jan;78(1):33-39

Cardiac tumors are among important group of cardiovascular diseases. Early diagnosis is necessary for the best management of the tumors. There are several imaging modalities available for cardiac tumors for diagnosis including echocardiography (transthoracic echocardiography, transesophageal echocardiography, 3 dimensional echocardiography) magnetic resonance imaging (MRI) and CT scan. However, echocardiography remains the best available noninvasive tool for the diagnosis of cardiac masses, while CT and MRI provide more information about the texture and extension of tumor.

Echocardiography provides useful information about the size, texture, location, extension of tumors, hemodynamic effects on heart such as stenosis.

Cardiac tumors can be found incidentally such as myxoma or left atrial thrombus in a patient with mitral stenosis. There is also different clinical presentation for cardiac masses such as constitutional symptoms, embolic events, fever etc.

Two groups of tumors can involve the heart: primary and secondary tumors. Primary tumors are rare with a prevalence of 0.001 to 0.03 percent in autopsies (1).The majority of primary tumors are benign such as myxoma, the most common form of primary tumors, responsible for half of these tumors (2). One fourth of cardiac tumors are malignant, and sarcomas with primary cardiac lymphomas are the most common malignant primary cardiac tumors (3).

Malignant primary cardiac tumors include: angiosarcoma, rhabdomyosarcoma, osteosarcoma, myxosarcoma, fibrosarcoma and synovial sarcoma. Various sarcomas and lymphomas are the most common primary malignant cardiac tumors (4, 5).

Metastatic tumors are 20 to 40 times more common than primary malignant ones with prevalence of 6% in post-mortem autopsies in malignant diseases (6). The most common tumors that metastasize to heart are from lung, breast, kidney, and liver; and among tumor variety, lymphoma, melanoma and osteogenic sarcoma (2).

Malignant tumors can metastasize to heart via hematogenous spread from inferior vena cava such as renal and hepatic tumors or via metastatic formation by systemic tumors such

Cardiac Tumors 155

Fig. 2. A 38 year old man with history of dyspnea. Myxoma can protrude through mitral valve and in M-mode mitral stenosis can be visualized as seen in this Echocardiograph.

as malignant melanoma, lymphomas, leukaemias and sarcomas. Lymphatics and direct invasion from adjacent organs such as lung and breast cancers or mediastinal lymphomas is another way of spread (7, 6).
