Imaging pitfalls, normal anatomy, and anatomical variants that can simulate disease on cardiac imaging as demonstrated on multidetector computed tomography

Terpenning, Silanath; White, Charles S.

doi:10.1177/2047981614562443

Cited by 13 publications

(12 citation statements)

References 31 publications

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“…and dissecting aneurysms, and (d) pericardial disease. Although we will focus on TTE pitfalls and limitations, it is important to highlight the fact that both cardiac CT and MR imaging also have many pitfalls and limitations (1)(2)(3). TTE, CT, and MR imaging are complementary imaging modalities and are invaluable to the cardiac imager when used together.…”

Section: Introductionmentioning

confidence: 99%

Transthoracic Echocardiography: Pitfalls and Limitations as Delineated at Cardiac CT and MR Imaging

et al. 2017

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Transthoracic echocardiography ( TTE transthoracic echocardiography ) is a critical tool in the field of clinical cardiology. It often serves as one of the first-line imaging modalities in the evaluation of cardiac disease owing to its low cost, portability, widespread availability, lack of ionizing radiation, and ability to evaluate both anatomy and function of the heart. Consequently, a large majority of patients undergoing a cardiac computed tomography (CT) or magnetic resonance (MR) imaging examination will have a TTE transthoracic echocardiography available for review. Therefore, it is imperative that cardiac imagers be familiar with the fundamentals of a routine TTE transthoracic echocardiography examination and common TTE transthoracic echocardiography pitfalls and limitations that may lead to a referral for cardiac CT or MR imaging. The four standard TTE transthoracic echocardiography windows and their corresponding views will be discussed and the relevant anatomy highlighted. Common pitfalls and limitations of TTE transthoracic echocardiography will be highlighted using cardiac CT and MR imaging as the problem-solving modality. In this article, we have categorized the relevant pitfalls and limitations of TTE transthoracic echocardiography into four broad categories: (a) masses and mass mimics (crista terminalis, eustachian valve, right ventricle moderator band, atrioventricular groove fat, left ventricular band [or left ventricular false tendon], hiatal hernia, caseous calcification of the mitral annulus, lipomatous hypertrophy of the interatrial septum, cardiac tumors), (b) poorly visualized apical lesions (aneurysm, thrombus, infarct, and hypertrophic and other nonischemic cardiomyopathies), (c) evaluation for ascending thoracic aortic dissections (false positive, false negative, dissecting aneurysms), and (d) pericardial disease (acute and chronic/constrictive pericarditis, pericardial tamponade, pericardial cysts and diverticula, congenital absence of the pericardium). Online supplemental material is available for this article. RSNA, 2017.

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Section: Introductionmentioning

confidence: 99%

Transthoracic Echocardiography: Pitfalls and Limitations as Delineated at Cardiac CT and MR Imaging

et al. 2017

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“…Diagnostic imaging of RA masses is challenging because RA structures such as a prominent pectinate, crista terminalis, eustachian, and thebesian valves can be misinterpreted. 6 Echocardiography is the first-line imaging study; however, it is unable to (1) differentiate myxomas from mural thrombi; (2) fully assess an invading cardiac mass; and (3) perform tissue characterization. 7 Nonconclusive echocardiographic findings are indications for cardiac magnetic resonance (CMR) or cardiac computerized tomography (CCT).…”

Section: Discussionmentioning

confidence: 99%

Incidental Finding of a Large Right Atrial Thrombus in a Patient With Cerebral Lymphoma

Fath

Aglan

Varkoly

et al. 2021

Journal of Investigative Medicine High Impact Case Reports

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Right atrial (RA) masses are rare, challenging to diagnose, and potentially life-threatening with high mortality if untreated. We present a patient presenting with diffuse large B-cell lymphoma in the brain that was incidentally found to have a large RA mass. For a better definition of the RA mass, extensive workup using multimodality imaging including chest computed tomography, transthoracic echocardiography, transesophageal echocardiography, cardiac magnetic resonance imaging, and left heart catheterization was warranted. The imaging demonstrated a large RA mass extending through the tricuspid valve into the right ventricle and superior and inferior vena cava without a mobile component. The mass was then successfully resected, and further histology examination was performed to rule out lymphoma and rare subtypes of diffuse large B-cell lymphoma. The comprehensive workup proved the RA mass to be a calcified thrombus rather than a direct metastatic spread of lymphoma.

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“…Other differential diagnoses of imaging pitfalls such as anatomical variants and other cardiac motion artifacts that mimic disease are still to be considered, 5 in especial the right atrium because of the prominence of the pectineus muscle, the terminal crest and the Eustachio and Thebesian valves, which can mimic thrombi or tumors on CT, and should proceed to diagnostic elucidation with magnetic resonance imaging or echocardiogram (Table 2). 5 A recent study demonstrated that a two-phase cardiac CTA showed 100% of sensitivity and 98% of specificity compared to transesophageal echocardiography for the assessment of thrombi located in the left atrial appendage in patients who suffered ischemic stroke. 11 Imaging acquisition technique on cardiac CTA is extremely specific, which allows a great evaluation of the heart chambers.…”

Section: Discussionmentioning

confidence: 99%

Atrial pseudothrombus, a new radiological sign of right atrial roof bulging, caused by pericardial effusion, observed on chest CT

Garcia¹,

Grassi²,

Gallafrio³

et al. 2019

IJRRT

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A 22-year-old female patient was admitted to the emergency room of an Oncologic center, with an acute onset of dry cough, hyaline runny nose, and sudden, severe, ventilatory-dependent chest pain, located in the parasternal region with shoulder irradiation, followed by dyspnea. On physical examination, associated findings are perioral and on the distal fingers' phalanges cyanosis. There was no history of fever, paresthesias, syncope, or other symptoms. Six years ago, in 2013, she had been diagnosed with 10th right costal arch Askin's tumor with pulmonary metastasis. Initially, she started receiving 1st line chemotherapy according to the Metastatic Ewing Sarcoma Protocol 2010, and then surgical approach for metastatic resection four right costal arches. So far, she has had three relapses, the first in 2016 for the left femur and lungs, in 2017 for the skullcap and 2018 for the right femur and right tibia. Since then, she has been receiving treatment according to an alternative chemotherapy protocol consisting by Topotecan 0.75mg/m² D1 to D5/CTX 250mg/m² D1 to D5 every 21 days and radiotherapy. A year ago, she developed a chronic thrombosis of the left brachiocephalic vein.

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Imaging pitfalls, normal anatomy, and anatomical variants that can simulate disease on cardiac imaging as demonstrated on multidetector computed tomography

Cited by 13 publications

References 31 publications

Transthoracic Echocardiography: Pitfalls and Limitations as Delineated at Cardiac CT and MR Imaging

Transthoracic Echocardiography: Pitfalls and Limitations as Delineated at Cardiac CT and MR Imaging

Incidental Finding of a Large Right Atrial Thrombus in a Patient With Cerebral Lymphoma

Atrial pseudothrombus, a new radiological sign of right atrial roof bulging, caused by pericardial effusion, observed on chest CT

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