A prominent crista terminalis associated with atrial septal aneurysm that mimics right atrial mass leading to atrial arrhythmias: a case report

Abstract

IntroductionThe crista terminalis is a variant of normal anatomical structures within the right atrium that mimics an atrial mass on a transthoracic echocardiogram. Atrial septal aneurysm is a rare but well-recognized cardiac abnormality of uncertain clinical significance. The association between crista terminalis and atrial septal aneurysm is unusual but not completely casual. Both anatomical heart structures can lead to atrial arrhythmias.Case presentationThis case report describes the accidental discovery during an echocardiographic examination of a 64-year-old Caucasian woman who had a left bundle branch block and palpitations.ConclusionThe clinical relevance of this anatomical evidence in unknown. This was an occasional finding of transthoracic echocardiography, but in this case it is possible to assume its relationship with the occurrence of atrial arrhythmias, and also that computed tomography scan and cardiovascular magnetic resonance is mandatory to define the structure and function of these incidental findings.

Atrial Septal Aneurysms and Supraventricular Arrhythmias: The Role of Atrial Electromechanical Delay

“…Atrial fibrillation is one of the most common SVAs observed in clinical practice . The relationship between ASAs and cardiac arrhythmias has been evaluated in various retrospective studies and case reports …”

“…Previous studies evaluated the predictive role of intra‐left AEMD for paroxysmal atrial fibrillation recurrence after cardioversion, lone atrial fibrillation attack, new‐onset AF after acute myocardial infarction, and occurrence of atrial arrhythmias in adult patients with congenital heart diseases . Few studies have evaluated the electrocardiographic and echocardiographic parameters reflecting heterogeneity of atrial depolarization in ASA patients, and only one previous study has analyzed the AEMD in healthy ASA population without interatrial shunt and the possible role of AEMD in early identifying SVAs in this population.…”

“…ASA has been reported to be associated with congenital heart diseases, systemic and pulmonary hypertension, thrombus formation, and thromboembolic stroke . Previous studies demonstrated an association between ASA and supraventricular arrhythmias (SVAs) and between ASA and atrial conduction disturbances . Little is still known about the association between ASA without interatrial shunt and SVAs .…”

Prominent crista terminalis mimicking a right atrial mass: a systematic literature review and meta-analysis

“…During TEE examination, in particular, the mid-esophageal bicaval view may be the best way to visualize the crista terminalis (6,39). However, currently in the presence of an unclear cardiac mass on echocardiography, patients are usually referred to CMR for further evaluation (16)(17)(18). On CMR studies, the crista terminalis is described as the structure connected to the RA and the right atrial auricle, which has a similar signal intensity to the myocardium, and does not show enhancement after contrast injection (1).…”

When is a mass not a mass? An unusual presentation of prominent crista terminalis

“…It extends along the posterolateral aspect of the right atrial wall. Occasionally, this variant structure can become unusually prominent, consequently mimicking a right atrial mass 2. We report a case of a prominent crista terminalis recognised and properly diagnosed by cardiac MRI (CMR).…”