Evaluation and Imaging Work-up:
Echocardiography, cardiac MRI, and CT angiogram are all acceptable techniques to characterize cardiac based tumors.
Echocardiographic features of PFE include: small size (< 15 mm), homogenous echo dense appearance, presence of pedicle or stalk, speckled pattern, tumor edge stippling, and independent mass mobility (Images 3,4).10, 18, 19 Tumors can appear round, oval or irregular; tumor multifocality has been reported in approximately 8% of cases.10 PFE can be distinguished from myxoma by tumor location and echocardiographic features.20, 21Sensitivity and specificity of TTE at identifying PFE greater than 0.2 cm has been estimated between 88.9 and 88.4%, respectively.10
Transesophageal echocardiogram is an important adjunct to TTE when a cardiac tumor is identified, to delineate tumor features and anatomic involvement of intracardiac structures.10 (Image 2). Computed tomography features of PFE include lobulated soft tissue density with a thin stalk.22 MR findings of PFE include hypointense mobile mass on T2 weighted imaging (Image 5).22 Challenges of both CT and MR include difficulty visualizing small tumors with cardiac motion artifact.23