0:00

And let's review one more case.

0:03

This is case 10.

0:06

In a patient who has chest pain.

0:10

Shortness of breath and tachycardia and these are axial

0:13

on the left and coronal on the

0:16

right images from a non-gated CT with

0:19

contrast.

0:21

Take a look.

0:24

See if you can identify the abnormality. I suspect that

0:27

that's going to be quite straightforward and then come

0:30

up with a diagnosis or differential diagnosis.

0:38

Okay.

0:40

This is left atrial maximum.

0:44

As we see there's a large mass situated squarely

0:47

within the left atrium.

0:50

I may be able to talk you into its association

0:54

with the interatrial septum,

0:57

which we don't clear clearly see but at least

1:00

on the axial image, we don't see it touching any other wall

1:03

on the coronal image. Maybe

1:06

there's some contact medially somewhere.

1:09

But but it looks like it's the best

1:12

guess here that it's arising from or at least

1:15

in contiguous with the interatrial septum.

1:19

the differential diagnosis that we would have

1:23

is

1:24

primarily left atrial maxoma secondarily large

1:27

list left atrial thrombus

1:30

clearly patients can have thrombus formation

1:33

in the left atrium, but it doesn't typically occur

1:36

here.

1:38

It typically occurs in left atrial appendage and

1:41

we would expect that the left atrium should

1:44

be dilated. Why do we expect that? Well, because

1:47

thrombus and left atrium occurs when you

1:50

have stasis and stasis occurs, usually in atrial fibrillation,

1:54

which itself is related to

1:57

a dilated.

1:58

left atrium

2:00

This looks like a normal size left atrium. And

2:03

it's got a big mass in it. So the leading Contender would be

2:06

left atrial maxoma. It's reasonable to do a

2:09

cardiac MRI and see if there's any enhancement, which

2:12

you

2:13

Expect to see in the maximum as

2:16

any self-respecting cardiac tumor

2:19

will show enhancement at some point.

2:22

after contrast

2:24

and just to clarify some Concepts

2:27

about cardiac masses 80% of

2:30

these are benign.

2:32

Because the majority of intracardiac masses

2:35

are intracavitary thrombot. This

2:38

is the most common, Mass.

2:42

Of the tumors in the heart. Those

2:45

are the tumors that

2:48

are not thrombus.

2:51

Metastases to the heart are 30 to 40

2:54

times more likely than primary tumors.

2:57

With regard to mixoma. This is a gelatinous

3:00

tumor that is high signal

3:03

on T2 weighted Imaging and it

3:06

generally shows heterogeneous enhancement.

3:09

We like to image several minutes after contrast as

3:12

well as immediately after contrast because sometimes these

3:15

these masses and other

3:18

cardiac masses take a while to to confidently show

3:21

enhancement.

3:23

And so with that I'm going to conclude this

3:26

presentation. We reached nice.

3:29

10 cases I am

3:33

Welcome to any any

3:36

questions or concerns that you all may have

3:39

about any of the cases that I've shown or if you have any additional questions

3:42

related to cardiac imaging

3:45

and be happy to entertain them. Thank you very much

3:48

for your attention. I really appreciate it.