IMAGING FEATURES OF NONMYXOMATOUS PRIMARY NEOPLASMS OF THE HEART AND PERICARDIUM DARRELL N. SMITH, KITT SHAFFER, AND EDWARD F. PATZ We present the imaging findings in 13 patients with nign tumors are myxomas, making myxomas the most common of all primary cardiac tumors. nonmyxomatous primary neoplasms of the heart and pericardium. Ten patients had abnormal chest films. Nonmyxomatous primary neoplasms of the heart and pericardium are a heterogeneous group of tu- While echocardiography was useful for determining origin of the tumor, CT (computed tomography) and mors and are much less common than metastases or myxomas. The most recent series from the Armed MRI (magnetic resonance imaging) were better at de- lineating extent of disease. The radiographic appear- Forces Institute of Pathology (AFIP) of 75 primary sarcomas of the heart only briefly mentions the ra- ance of these rare neoplasms of the heart and peri- cardium is varied. Cross-sectional imaging plays a diological findings (3). Large series, reported from France (53 patients) (4), University of Minnesota (23 crucial role in the surgical planning and management of these patients.  Elsevier Science Inc., 1998 patients) (5), M.D. Anderson (21 patients) (6), and the Mayo Clinic (8 patients) (7) did not focus on ra- diologic imaging. KEY WORDS: More recent smaller series (8–13) have described Cardiac neoplasms; Echocardiography; Computed the important contribution of cross-sectional imaging tomography; Magnetic resonance imaging by computed tomography (CT) and magnetic reso- nance imaging (MRI). The remainder of the literature is restricted to case reports or few examples (14–17). INTRODUCTION Because the preoperative diagnosis can be difficult, Primary tumors of the heart and pericardium are we retrospectively reviewed 13 cases of primary neo- rare. Most cardiac tumors represent metastases, most plasms of the heart and the pericardium, excluding commonly from a lung primary (1). Pooled data from myxomas and metastatic disease in order to describe 22 large autopsy series of primary tumors of the heart the spectrum of imaging features of these rare tu- mors. We included tumors arising from both the showed the frequency to be approximately 0.02% or heart and the pericardium, since the exact site of ori- 200 tumors in 1 million autopsies (2). Three quarters gin can be difficult to distinguish preoperatively in of these tumors were benign and one quarter were these locations. malignant overall. Approximately one-half of the be- MATERIALS AND METHODS From the Department of Radiology (D.N.S.) Brigham and Wom- en’s Hospital, Boston, Massachusetts, Department of Radiology Thirteen patients with pathologically proven primary (K.S.), Dana-Farber Cancer Institute, Boston, Massachusetts, and nonmyxomatous neoplasms of the heart and pericar- Department of Radiology (E.F.P.), Duke University, Durham, North Carolina. dium were identified by retrospective review of pa- Address reprint requests to: Darrell N. Smith, MD, Brigham thology reports over the last 9 years at three institu- and Women’s Hospital, Department of Radiology, L-1, 75 Francis tions. The review included all patients for whom Street, Boston, MA 02115. Received September 12, 1996; accepted November 15, 1996. imaging was available for review. CLINICAL IMAGING 1998;22:15–22  Elsevier Science Inc., 1998. All rights reserved. 0899-7071/98/$19.00 655 Avenue of the Americas, New York, NY 10010 PII S0899-7071(97)00070-3