To explore the clinical, pathological, and echocardiographic features of primary non-mucinous cardiac tumors (PNCTs).

The clinical manifestations, echocardiographic features, and surgical pathological data of 51 patients with PNCTs confirmed at Wuhan Asia Heart Hospital from January 2005 to June 2021 were analyzed retrospectively. According to pathological results, there were 35 cases of benign tumors and 16 cases of malignant tumors.

The clinical manifestations of 51 patients with PNCT were mainly chest tightness and shortness of breath in 23 cases, chest pain in 5, dyspnea in 8, syncope in 6, lower limb edema in 4, and no obvious clinical symptoms in 16 cases; 28 patients had different degrees of arrhythmia. Among the 51 patients included, the proportion of benign tumors (68.6%, 35/51) was higher than that of malignant tumors (31.4%, 16/51). Hemangioma (22.8%, 8/35), fibroma (17.1%, 6/35), and lipoma (17.1%, 6/35) were the most common in benign PNCT patients, while sarcoma (62.5%, 10/16) was the most common in malignant tumors, followed by lymphoma (37.5%, 6/16). Among the patients with malignant tumors, the right cardiac system had the highest incidence rate at 75.0%, which was statistically higher compared with the incidence rate in the left cardiac system (12.5%) and pericardium (12.5%) (P＜0.05). There was no statistically significant difference in the proportion of benign PNCT patients among different sites (P＞0.05). The echocardiographic characteristics of benign and malignant PNCTs were significantly different with regard to tumor shape, basal width, surrounding tissue invasion, and pericardial effusion (P＜0.05). Myocardial contrast echocardiography was assessed for 19 patients; pericardial cyst and blood cyst showed no enhancement, fibroma, rhabdomyoma, and lipoma showed mild enhancement, and sarcoma and lymphoma showed uniform or uneven enhancement.

PNCTs are mostly benign, malignant tumors more commonly occur in the right cardiac system, and the clinical manifestations are lack of specificity. Echocardiography and myocardial contrast echocardiography can differentiate malignant and benign tumors. The incidence rate, location, and echocardiographic characteristics of tumors are helpful to the qualitative diagnosis of PNCTs.