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      Cardiac Masses in Echocardiography: A Pragmatic Review

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          Abstract

          Transthoracic echocardiography is a useful diagnostic technique for the identification of intracardiac and extracardiac masses, which can evaluate morphologic properties of the masses such as their location, attachment, shape, size, mobility, and possible hemodynamic-related implications. Apart from physiological variants and structural normal mimickers, echocardiography can detect principal intracardiac masses such as neoplasms, thrombi, vegetation, and extracardiac masses such as metastatic lesions. Moreover, transesophageal echocardiography can provide further details and provide higher accuracy in case a deeper examination of the mass is needed. This review will focus on the systematic evaluation of intra-/extracardiac masses including epidemiology and morphological and echocardiographic features, providing practical and technical tips to health-care professionals to achieve correct identification of the masses. General data on cardiac masses were extracted via PubMed/MEDLINE search engine from indexed reviews, original studies, and clinical case reports. The echocardiographic features of cardiac masses were reviewed according to the most relevant international cardiology and echocardiography scientific societies' position statements.

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          Most cited references43

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          2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC)

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            Tumors of the heart. A 20-year experience with a review of 12,485 consecutive autopsies.

            Cardiac involvement by primary and secondary tumors is one of the least investigated subjects in oncology. Seven cases of primary and 154 cases of secondary cardiac tumors from autopsies performed over a 20-year period (1972 through 1991) at Queen Mary Hospital, Hong Kong, were reviewed. During this period, 12,485 autopsies were performed, and the autopsy incidence for primary and secondary heart tumors is thus 0.056% and 1.23%, respectively. Only seven primary cardiac tumors were found, including two myxomas, two rhabdomyomas, two hemangiomas, and one lipoma. For secondary tumors involving the heart (including both metastasis and local extension), important primary tumors in male subjects were carcinoma of the lung (31.7%), esophageal carcinoma (28.7%), lymphoma (11.9%), carcinoma of the liver (6.9%), leukemia (4.0%), and gastric carcinoma (4.0%), while in female subjects, carcinoma of the lung (35.9%), lymphoma (17.0%), carcinoma of the breast (7.5%), and pancreatic carcinoma (7.5%) predominated. Overall, the three most common malignant neoplasms encountered were carcinoma of the lung, esophageal carcinoma, and lymphoma. Pericardium, including epicardium, was the most common location of cardiac involvement by secondary tumors, followed by myocardium and endocardium. The present study showed a higher percentage of esophageal carcinoma and carcinoma of the liver (reflecting the higher incidence of these tumors in Hong Kong Chinese), but a lower incidence of carcinoma of the breast when compared with other series. The metastatic lung tumors showed an unusual predominance of adenocarcinoma.
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              Changing profile of infective endocarditis: results of a 1-year survey in France.

              Since the first modern clinical description of infective endocarditis (IE) at the end of the 19th century, the profile of the disease has evolved continuously, as highlighted in epidemiological studies including a French survey performed in 1991. To update information gained from the 1991 study on the epidemiology of IE in France. Population-based survey conducted from January through December 1999 in all hospitals in 6 French regions representing 26% of the population (16 million inhabitants). Three hundred ninety adult inpatients diagnosed with IE according to Duke criteria. Incidence of IE; proportion of patients with underlying heart disease; clinical characteristics; causative microorganisms; surgical and mortality outcomes. The annual age- and sex-standardized incidence was 31 (95% confidence interval [CI], 28-35) cases per million, not including the region of New Caledonia, which had 161 (95% CI, 117-216) cases per million. There was no previously known heart disease in 47% of the cases. The proportion of prosthetic-valve IE was 16%. Causative microorganisms were: streptococci, 48% (group D streptococci, 25%; oral streptococci, 17%, pyogenic streptococci, 6%); enterococci, 8%; Abiotrophia species, 2%; staphylococci, 29%; and other or multiple pathogens, 8%. Blood cultures were negative in 9% and no microorganism was identified in 5% of the cases. Early valve surgery was performed in 49% of the patients. In-hospital mortality was 16%. Compared with 1991, this study showed a decreased incidence of IE in patients with previously known underlying heart disease (20.6 cases per million vs 15.1 cases per million; P<.001); a smaller incidence of oral streptococcal IE (7.8 cases per million vs 5.1 cases per million; P<.001), compensated by a larger proportion of IE due to group D streptococci (5.3 cases per million vs 6.2 cases per million; P =.67) and staphylococci (4.9 cases per million vs 5.7 cases per million; P =.97); an increased rate of early valve surgery (31.2% vs 49.7%; P<.001); and a decreased in-hospital mortality rate (21.6% vs 16.6%; P =.08). Although the incidence of IE has not changed, important changes in disease characteristics, treatment, and outcomes were noted.

                Author and article information

                Journal
                J Cardiovasc Echogr
                J Cardiovasc Echogr
                JCE
                Journal of Cardiovascular Echography
                Wolters Kluwer - Medknow (India )
                2211-4122
                2347-193X
                Jan-Mar 2020
                13 April 2020
                : 30
                : 1
                : 5-14
                Affiliations
                [1]Department of Cardiology, San Giovanni Di Dio Hospital, Gorizia, Italy
                [1 ]Department of Cardiology, Giovan Battista Grassi Hospital, Rome, Italy
                Author notes
                Address for correspondence: Dr. Paolo Diego L’Angiocola, Department of Cardiology, San Giovanni Di Dio Hospital, Via Fatebenefratelli, 34, 34170 Gorizia, Italy. E-mail: paolo.doc@ 123456gmail.com
                Article
                JCE-30-5
                10.4103/jcecho.jcecho_2_20
                7307625
                32766100
                89b22805-9103-4dd1-a62b-914f99653aef
                Copyright: © 2020 Journal of Cardiovascular Echography

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 07 January 2020
                : 18 February 2020
                : 25 February 2020
                Categories
                Review Article

                cardiac masses,echocardiography,neoplasia,thrombus,vegetation

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