Cardiac MRI as a useful tool to differentiate tumor and thrombus

Excerpt

A 56-year-old male with a history of systemic lupus erythematosus presented with subacute progressive respiratory distress with systemic B symptoms. On physical examination, he had a regular tachycardia with hypoxia and scattered lymphadenopathy. CT angiogram performed in the emergency room revealed a large mass in the right ventricle (RV) extending into the RV outflow tract without a pulmonary embolism (Fig. 1, panel a). Transthoracic echocardiogram confirmed the presence of a RV mass with near complete cavity obliteration (Fig. 1, panel b, c). The next step to differentiate the etiology of this substantial mass as tumor or thrombus was a clinical challenge given the history of lymphadenopathy and systemic B symptoms. Cardiac magnetic resonance imaging (CMR) was utilized which showed a mass measuring significantly larger than the prior modalities at 8.1 × 2.5 × 2.4 cm in the RV abutting the interventricular septum and extending into the RV outflow tract reaching up to the pulmonary valve (Fig. 1, panel d, e). By utilizing the multiple CMR views and series, the mass was unequivocally identified as a thrombus as it had characteristics specific for this including lack of contrast enhancement and presence of MR blood products signature signal, lack of normal signal void on the black blood in the axial view (Fig. 1, panel f), lack of enhancement on first pass perfusion (Fig. 1, panel g) and on post contrast views (Fig. 1, panel h), and persistence of hypointense signal on late gadolinium enhancement (Fig. 1, panel i). …