Cardiac Mass
Michael D. Puchalski, MD
DIFFERENTIAL DIAGNOSIS
Common
Echogenic Cardiac Focus
Moderator Band
Papillary Muscle
Less Common
Rhabdomyoma
Hypertrophic Muscle
Rare but Important
Teratoma
Fibroma
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
Is the mass echogenic?
Is it associated with the papillary muscle?
Single or multiple masses?
Where are they located?
Ventricle, septum, or on pericardium
Helpful Clues for Common Diagnoses
Echogenic Cardiac Focus
Normal intracardiac anatomy
Focus is bright as bone
Small, associated with papillary muscle
Usually incidental finding but is a soft marker for trisomy 21
Moderator Band
Distinguishing feature that identifies right ventricle
Normal muscle band from free wall to septum at 45° angle near apex
Papillary Muscle
Normal feature of right and left ventricles
Left ventricular papillary muscles do not connect to septum: Defining feature of a morphologic left ventricle
Helpful Clues for Less Common Diagnoses
Rhabdomyoma
Multiple, ventricular echogenic masses
Varying sizes
Typically resolve with time
Associated with tuberous sclerosis, look carefully at brain
Hypertrophic Muscle
Often with asymmetric septal hypertrophy, not echogenic
Hypertrophy is uniform and concentric
Helpful Clues for Rare Diagnoses
Teratoma
May be intra- or extrapericardial
Pericardial effusion common
Fibroma
Typically a single tumor involving left ventricular free wall or septum
May be large causing outflow obstruction
Other Essential Information
Echogenic cardiac focus is most commonly benign and not associated with cardiac pathology
If multiple may be associated with aneuploidy
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