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
Inferior vena cava 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 with 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
Bussani R et al: Cardiac tumors: diagnosis, prognosis, and treatment. Curr Cardiol Rep. 22(12):169, 2020
Maleszewski JJ et al: Neoplasia and the heart: pathological review of effects with clinical and radiological correlation. J Am Coll Cardiol. 72(2):202-27, 2018
Lichtenberger JP 3rd et al: Metastasis to the heart: a radiologic approach to diagnosis with pathologic correlation. AJR Am J Roentgenol. 207(4):764-72, 2016
Bogaert J et al: Pericardial disease: value of CT and MR imaging. Radiology. 267(2):340-56, 2013
Motwani M et al: MR imaging of cardiac tumors and masses: a review of methods and clinical applications. Radiology. 268(1):26-43, 2013
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
Prakash P et al: Imaging findings of pericardial metastasis on chest computed tomography. J Comput Assist Tomogr. 34(4):554-8, 2010
Butany J et al: Cardiac tumours: diagnosis and management. Lancet Oncol. 6(4):219-28, 2005
González Valverde FM et al: Pericardial tamponade as initial presentation of papillary thyroid carcinoma. Eur J Surg Oncol. 31(2):205-7, 2005
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
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
Inferior vena cava 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 with 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
Bussani R et al: Cardiac tumors: diagnosis, prognosis, and treatment. Curr Cardiol Rep. 22(12):169, 2020
Maleszewski JJ et al: Neoplasia and the heart: pathological review of effects with clinical and radiological correlation. J Am Coll Cardiol. 72(2):202-27, 2018
Lichtenberger JP 3rd et al: Metastasis to the heart: a radiologic approach to diagnosis with pathologic correlation. AJR Am J Roentgenol. 207(4):764-72, 2016
Bogaert J et al: Pericardial disease: value of CT and MR imaging. Radiology. 267(2):340-56, 2013
Motwani M et al: MR imaging of cardiac tumors and masses: a review of methods and clinical applications. Radiology. 268(1):26-43, 2013
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
Prakash P et al: Imaging findings of pericardial metastasis on chest computed tomography. J Comput Assist Tomogr. 34(4):554-8, 2010
Butany J et al: Cardiac tumours: diagnosis and management. Lancet Oncol. 6(4):219-28, 2005
González Valverde FM et al: Pericardial tamponade as initial presentation of papillary thyroid carcinoma. Eur J Surg Oncol. 31(2):205-7, 2005
Chiles C et al: Metastatic involvement of the heart and pericardium: CT and MR imaging. Radiographics. 21(2):439-49, 2001
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