An unusual presentation of prominent crista terminalis mimicking a right atrial mass: a case report

Abstract

BackgroundThe crista terminalis is a variation of normal anatomical structure within the right atrium which may be misdiagnosed with an abnormal atrial mass normally visualized in the standard views on the transthoracic echocardiogram.Case presentationIn this case presentation, we demonstrated a rare case report describing the accidental discovery of a right atrial mass-like structure in a 54-year old Asian man without physical discomfort during an echocardiographic examination. These findings naturally caused some concern as the differential diagnosis such as right atrial myxoma or thrombus and further examination were organized. The subsequent positron emission tomography/magnetic resonance imaging (PET/MRI) differentiated a true right atrial mass from a strip extending into the atrium in accordance with prominent crista terminalis.ConclusionA preferable understanding of the complex anatomy and PET/MRI appearance of a prominent crista terminalis will minimize the misdiagnosis of this structure and avoiding unnecessary anxiety and more invasive examinations.Electronic supplementary materialThe online version of this article (10.1186/s12872-018-0925-y) contains supplementary material, which is available to authorized users.

Catheter‑related giant right atrial thrombosis mimicking a myxoma: A case report

“…The differential diagnosis of RAMs remains a challenge, despite having new imaging techniques. Cardiac mass detection is based on the use of echocardiography, computed tomography and cardiac MRI, with echocardiography being the primary choice (1,9). Right atrial myxomas can be hard to differentiate from right atrial thrombus (10), as was evident in this case report.…”

“…The presence of a right atrial mass (RAM), despite the advanced diagnostic modalities available, still poses a diagnostic dilemma. RAM constitutes tumors, thrombus, prominent crista terminalis, or endocarditis vegetation (1). Cardiac myxomas are benign and are the most common primary cardiac tumor, 15% of atrial myxomas arise in the right atrium (RA), and they are usually attached to the interatrial septum (2,3).…”

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

“…The crista terminalis is an anatomical structure localized on the posterolateral wall in the superior aspect of the right atrium (RA) (1). It results from regression of the septum spurium and is formed from the fusion of right angle of the venous sinus, the superior inferior vena cava, and the original atrium during fetal life (1,2). Interestingly, so far there have been three cases reporting prominent crista terminalis found in the fetus and confirmed in the neonatal period (3)(4)(5).…”

Solving the Diagnostic Challenge of Right Atrial Mass

“…TEE offers an alternative imaging field, uses higher-frequency ultrasound with improved axial resolution, and can provide detailed anatomical information. It can delineate normal anatomical variants, such as crista terminalis, 1 a prominent eustachian valve, and a Chiari network, and can identify benign conditions, such as lipomatous hypertrophy of the interatrial septum, with greater diagnostic confidence. It is also widely used for diagnosing thrombi and vegetations.…”