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Cardiac and Pericardial Metastases
John P. Lichtenberger, III, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Definitions

                • Metastases to heart and pericardium occur via
                  • Lymphatic spread: Most common route; lung and breast cancer
                  • Hematogenous spread: Typically melanoma; other sites usually involved
                  • Direct extension: Lung cancer and other thoracic malignancies; rarely mesothelioma
                  • Transvenous spread
                    • IVC from renal cell carcinoma, hepatocellular carcinoma, adrenal and uterine malignancies
                    • Pulmonary vein from lung cancer
                • Pericardial involvement in ~ 5-10% of late-stage cancer
                • ~ 15% of cytologically examined pericardial effusions are malignant
                • Malignant pericardial effusion in ~ 40% of patients metastases to heart and pericardium

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Echocardiographic Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Image Interpretation Pearls

                                            Selected References

                                            1. Bogaert J et al: Pericardial Disease: Value of CT and MR Imaging. Radiology. 267(2):340-56, 2013
                                            2. Motwani M et al: MR imaging of cardiac tumors and masses: a review of methods and clinical applications. Radiology. 268(1):26-43, 2013
                                            3. Buckley O et al: Cardiac masses, part 2: key imaging features for diagnosis and surgical planning. AJR Am J Roentgenol. 197(5):W842-51, 2011
                                            4. Prakash P et al: Imaging findings of pericardial metastasis on chest computed tomography. J Comput Assist Tomogr. 34(4):554-8, 2010
                                            5. Butany J et al: Cardiac tumours: diagnosis and management. Lancet Oncol. 6(4):219-28, 2005
                                            6. González Valverde FM et al: Pericardial tamponade as initial presentation of papillary thyroid carcinoma. Eur J Surg Oncol. 31(2):205-7, 2005
                                            7. Chiles C et al: Metastatic involvement of the heart and pericardium: CT and MR imaging. Radiographics. 21(2):439-49, 2001
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Pathology

                                                    • Clinical Issues

                                                      • Diagnostic Checklist

                                                        TERMINOLOGY

                                                        • Definitions

                                                          • Metastases to heart and pericardium occur via
                                                            • Lymphatic spread: Most common route; lung and breast cancer
                                                            • Hematogenous spread: Typically melanoma; other sites usually involved
                                                            • Direct extension: Lung cancer and other thoracic malignancies; rarely mesothelioma
                                                            • Transvenous spread
                                                              • IVC from renal cell carcinoma, hepatocellular carcinoma, adrenal and uterine malignancies
                                                              • Pulmonary vein from lung cancer
                                                          • Pericardial involvement in ~ 5-10% of late-stage cancer
                                                          • ~ 15% of cytologically examined pericardial effusions are malignant
                                                          • Malignant pericardial effusion in ~ 40% of patients metastases to heart and pericardium

                                                        IMAGING

                                                        • General Features

                                                          • Radiographic Findings

                                                            • CT Findings

                                                              • MR Findings

                                                                • Echocardiographic Findings

                                                                  • Imaging Recommendations

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Gross Pathologic & Surgical Features

                                                                          • Microscopic Features

                                                                            CLINICAL ISSUES

                                                                            • Presentation

                                                                              • Demographics

                                                                                • Natural History & Prognosis

                                                                                  • Treatment

                                                                                    DIAGNOSTIC CHECKLIST

                                                                                    • Image Interpretation Pearls

                                                                                      Selected References

                                                                                      1. Bogaert J et al: Pericardial Disease: Value of CT and MR Imaging. Radiology. 267(2):340-56, 2013
                                                                                      2. Motwani M et al: MR imaging of cardiac tumors and masses: a review of methods and clinical applications. Radiology. 268(1):26-43, 2013
                                                                                      3. Buckley O et al: Cardiac masses, part 2: key imaging features for diagnosis and surgical planning. AJR Am J Roentgenol. 197(5):W842-51, 2011
                                                                                      4. Prakash P et al: Imaging findings of pericardial metastasis on chest computed tomography. J Comput Assist Tomogr. 34(4):554-8, 2010
                                                                                      5. Butany J et al: Cardiac tumours: diagnosis and management. Lancet Oncol. 6(4):219-28, 2005
                                                                                      6. González Valverde FM et al: Pericardial tamponade as initial presentation of papillary thyroid carcinoma. Eur J Surg Oncol. 31(2):205-7, 2005
                                                                                      7. Chiles C et al: Metastatic involvement of the heart and pericardium: CT and MR imaging. Radiographics. 21(2):439-49, 2001