Fig. 17. Transesophageal echocardiography revealed a large mass attached to the posterior mitral valve leaflet. Histological examination revealed that it was a melanoma, arising from an extracardiac primary. (Please see companion DVD for corresponding video.)

Chamber Echocardiography
Fig. 18. Apical four-chamber (A4C) view showing compression of the right heart chambers from a large pleural mesothelioma. (Please see companion DVD for corresponding video.)

pericardial or myocardial invasion (please see companion DVD for corresponding video).

Metastatic spread frequently occurs by either direct extension to the pericardium, or via lymphangitic or hematogenous spread. Renal cell carcinoma, Wilms' tumor, and hepatocellular carcinoma can invade the right atrium by encroaching up the IVC, and bron-chogenic neoplasms can enter the left atrium via the pulmonary veins. The involvement of pericardium or invasion of the tumor from either the cardiac free walls (as opposed to septum) or contiguous great vessels may be a clue to the secondary nature of these tumors. Clinical symptoms from secondary metastases are often the result of associated pericardial effusion and, less frequently, to embolization or mass effect on the myocardium (see next section).

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Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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