CTICasesRadiation-Induced Cardiac Sarcoma
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Imaging findings
Contrast-enhanced chest CT demonstrates an infiltrative mass in the posterior aspect of the left atrium that causes severe narrowing or occlusion of the left inferior and right inferior pulmonary veins, with central obstruction of pulmonary venous return leading to dependent lower lobe venous congestion. Cardiac MRI shows an avidly enhancing mass that is highly vascular on perfusion sequences, demonstrating rapid contrast uptake and delayed hyperenhancement, while a TI inversion scout sequence shows the mass nulling just after the blood pool and well before the myocardium. Associated paramediastinal fibrotic changes and accelerated coronary and aortic atherosclerosis are also present within the prior radiation field.
Key takeaways
Primary cardiac sarcomas are rare malignant tumors that often arise in the left atrium (unlike angiosarcomas, which typically arise in the right atrium) and can mimic primary lung masses or metastatic lesions crawling into the pulmonary veins. Patients with a history of radiation therapy for Hodgkin lymphoma are at increased risk for developing radiation-induced sarcomas, as well as accelerated atherosclerosis and mediastinal fibrosis within the prior radiation port. On MRI, prompt, intense perfusion and delayed enhancement help differentiate sarcomas from cardiac thrombus, which does not enhance.
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