Cardiac tumor is rare, with an estimated cumulative prevalence of 0.002–0.3 % at autopsy. Metastatic cardiac
tumor is approximately 40 times more common than primary cardiac tumors. The majority of primary cardiac tumor is benign, and benign cardiac tumors manifest as intracavitary, mural, or epicardial focal masses, whereas malignant tumors show infi ltrative growth and can invade adjacent coronary arteries [ 1 , 27 ]. The mechanism of refractory angina is that an intracavitary tumor, especially myxoma, causes thrombus or tumor fragments to embolize into the coronary artery (Fig. 9.10 ), whereas myocardial or extracardiac tumors extrinsically compress the coronary artery (Fig. 9.15 ) [ 1 , 27 ].
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c d
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Fig. 9.10 An 83-year-old woman with atrial fi brillation and ST-elevated myocardial infarction as a result of embolic occlusion of the coronary artery by left atrial appendage thrombus (Courtesy of Jeong A Kim, Bundang Seoul National University Hospital). ( a ) Oblique coro- nal image shows hypoattenuating thrombus at the left atrial append- age ( arrow ). ( b ) Curved multiplanar reformation image shows total occlusion of the left anterior descending artery by hypoattenuating
thrombus with enhanced wall. ( c ) Four-chamber image shows corresponding myocardial hypoenhancement ( arrows ) in the basal to mid anterior and septal wall, which is compatible with acute myo- cardial infarction. ( d ) Invasive coronary angiography image confi rms focal fi lling defect ( arrows ) indicating emboli at the mid left anterior descending artery and the diagonal branch
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Fig. 9.11 A 61-year-old man with acute chest pain (Courtesy of Hyun Ju Seon, Chonnam National University Hospital). ( a ) Resting perfusion MR image shows subendocardial perfusion defect ( arrowhead ) at mid inferoseptal and inferior wall, indicating the territory of the right coro- nary artery. ( b ) Ten-minute delayed MR image using phase-sensitive inversion recovery sequence after administration of gadolinium con- trast shows subendocardial delayed enhancement at the same area
( arrowhead ), indicating myocardial infarction. ( c ) Invasive coronary angiography image shows no stenosis at the right coronary artery.
Invasive coronary angiography image obtained after intracoronary administration of ergonovine shows provoked high-grade luminal ste- nosis ( arrow ) at the distal right coronary artery that was completely relieved by intracoronary administration of nitroglycerin
a b
Fig. 9.12 A 46-year-old man with an iatrogenic coronary artery dissec- tion. ( a ) The coronary CT angiography after failed percutaneous coro- nary artery intervention shows coronary artery dissection and an intimal
fl ap in the right coronary artery. The false lumen ( arrow ) is partly thrombosed. ( b ) The intimal fl ap extends to the distal right coronary artery
b a
Fig. 9.13 A 66-year-old man with acute myocardial infarction due to extrinsic compression of the coronary artery by pseudoaneurysm. ( a ) Transaxial image shows a large pseudoaneurysm with surrounding hematoma at the ascending aorta. This is a contained rupture of the ascending aorta with a large defect at the lateral wall. ( b ) Transaxial image shows extrinsic compression of the left anterior descending
artery and the diagonal branches by surrounding hematoma. Transaxial image shows corresponding myocardial hypoenhancement ( arrow- heads ) at the apical anterior and septal wall of the left ventricle indicat- ing acute myocardial infarction. The patient underwent emergent ascending aorta replacement. Pathologic report revealed aortic rupture caused by a penetrating atherosclerotic ulcer
Fig. 9.14 A 54-year-old man with Behcet’s disease. ( a ) Maximum intensity projection image shows pseudoaneurysm ( arrow ) involving the posterior wall of the left ventricular outfl ow tract. Surrounding
hematoma is also seen extending to the ascending aorta. ( b ) Curved multiplanar reformation of the right coronary artery shows focal steno- sis ( arrowhead ) of the proximal segment due to surrounding hematoma
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b
c
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c b a
Fig. 9.15 A 62-year-old man with acute chest pain (Courtesy of Hyun Ju Seon, Chonnam National University Hospital). This patient had a history of left pneumonectomy due to squamous cell lung cancer.
( a ) Oblique transaxial image shows infi ltrative and irregular hypoat- tenuating mass invading to the left heart, suggestive of recurred lung cancer. Note that the left circumfl ex ( arrow ) artery was entirely encased
by the mass. ( b ) Short-axis image clearly shows a thorough encase- ment of the left anterior descending coronary artery ( arrowhead ) and the ramus intermedius by recurred lung cancer. ( c ) Invasive coronary angiogram shows long segmental fi xed luminal narrowing and irreg- ularity of the left circumfl ex artery ( arrows ) ( http://extras.springer.
com/2015/978-3-642-36396-2 )