Primary cardiac synovial sarcoma
A. Cardiac magnetic resonance imaging
A cardiac magnetic resonance image (cMRI) was the next imaging modality chosen, because it provided more information regarding the new left ventricular dysfunction and markedly abnormal strain. A cMRI provides optimal multiplanar images for tissue and blood flow characterization without radiation. Since a malignant condition is in the differential diagnosis in a patient with a cardiac mass, constitutional symptoms, pulmonary nodules, and mediastinal lymphadenopathy, T1-weighted and T2-weighted images were better able to distinguish different tumor characteristics than a positron emission tomography–computed tomography (PET-CT) scan (choice B).1,2 Furthermore, a transesophageal echocardiogram (choice D) would not provide further tissue characterization of the right atrial mass. For example, more vascularized masses are enhanced on T1-weighted imaging, and areas of hemorrhage, edema, and necrosis are enhanced on T2-weighted imaging. Additionally, the use of first-pass perfusion imaging with early and late gadolinium enhancement can identify infiltration, thrombus, and hemorrhage.1- 4 This combination of findings can create a virtual fingerprint to differentiate between cardiac masses, such as fibromas, myxomas, and sarcomas, and assist in biopsy guidance. For these reasons, a cMRI was pursued prior to a PET-CT scan.