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Nalawade DD, Wadhokar PS, Jadhav AK, Manade VV. Prominent Crista Terminalis Mimicking Right Atrial Thrombus in a Case of Permanent Pacemaker Implantation - Role of Two- and Three-Dimensional Transesophageal Echocardiography. J Cardiovasc Echogr 2024; 34:149-151. [PMID: 39444384 PMCID: PMC11495316 DOI: 10.4103/jcecho.jcecho_2_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 06/22/2023] [Accepted: 08/06/2024] [Indexed: 10/25/2024] Open
Abstract
Crista terminalis is a crescent-shaped fibromuscular ridge in the posterolateral wall of the right atrium (RA) which separates the smooth posterior region of RA from a more muscular anterior region. When prominent, it frequently mimics RA thrombus, vegetation, or tumors such as myxoma. Differentiation of such anatomical structural variations from other masses is vital to minimize misdiagnosis and avoid disease-related apprehension. Different diagnostic modalities may be needed which have their own imaging characteristics as well as limitations. Our case emphasizes the differentiating features of prominent crista terminalis using two-dimensional and three-dimensional transesophageal echocardiography.
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Affiliation(s)
- Digvijay D. Nalawade
- Department of Cardiology, Dr. D. Y. Patil Medial College, Hospital and Research Centre, Pune, Maharashtra, India
| | - Pratik Satyajit Wadhokar
- Department of Cardiology, Dr. D. Y. Patil Medial College, Hospital and Research Centre, Pune, Maharashtra, India
| | - Ajitkumar Krishna Jadhav
- Department of Cardiology, Dr. D. Y. Patil Medial College, Hospital and Research Centre, Pune, Maharashtra, India
| | - Vivek V. Manade
- Department of Cardiology, Dr. D. Y. Patil Medial College, Hospital and Research Centre, Pune, Maharashtra, India
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Matusik PS, Mikrut K, Bryll A, Podolec M, Popiela TJ, Matusik PT. Prominent crista terminalis mimicking a right atrial mass: a systematic literature review and meta-analysis. Acta Radiol 2024; 65:588-600. [PMID: 38619912 DOI: 10.1177/02841851241242461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
The crista terminalis is an anatomical structure localized on the posterolateral wall of the right atrium (RA). We performed a systematic review of the literature and meta-analysis concerning cases of unusual prominent crista terminalis mimicking RA mass. Moreover, we described the differential diagnosis of cardiac masses with the use of echocardiography, computed tomography, and cardiac magnetic resonance (CMR). We also emphasize the potential importance of this structure in electrophysiological procedures, including its role in exaggerated arrhythmias. Prominent crista terminalis may be a potential obstacle during invasive cardiac procedures or catheter ablation target. In analyzed cases, the crista terminalis was often erroneously interpreted as pathologic and at first confused with a thrombus or tumor during transthoracic echocardiography examination. The correct final diagnoses were mostly made with used transesophageal echocardiography or CMR. The most important imaging findings suggestive of prominent crista terminalis rather than tumor were a similar echogenicity/intensity with adjacent myocardium, the location on posterolateral wall of the RA, the phasic change in size, and no enhancement after contrast injection. We describe up to date and detailed imaging features for the differential diagnostics of selected intracardiac masses using various imaging techniques, including multimodality cardiac imaging. Familiarity with the anatomy and the imaging findings of the prominent crista terminalis will reduce misdiagnosis and avoid additional tests and unwarranted clinical interventions, while in patients considered for invasive cardiac procedures it might increase their efficacy and safety.
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Affiliation(s)
- Patrycja S Matusik
- Department of Diagnostic Imaging, University Hospital, Kraków, Poland
- Chair of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Katarzyna Mikrut
- Department of Cardiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Amira Bryll
- Department of Diagnostic Imaging, University Hospital, Kraków, Poland
- Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz Podolec
- Department of Coronary Artery Disease and Heart Failure, St John Paul II Hospital, Kraków, Poland
- Center for Innovative Medical Education, Jagiellonian University Medical College, Kraków, Poland
| | - Tadeusz J Popiela
- Department of Diagnostic Imaging, University Hospital, Kraków, Poland
- Chair of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Paweł T Matusik
- Department of Electrocardiology, Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
- Department of Electrocardiology, St John Paul II Hospital, Kraków, Poland
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Kumar SS, Mondal S, Kesavan V. Right atrial mass. Heart 2024; 110:424-458. [PMID: 38395440 DOI: 10.1136/heartjnl-2023-323588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Affiliation(s)
- Swasthi S Kumar
- Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Sudipta Mondal
- Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Vishnu Kesavan
- Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Affiliation(s)
- Sunita Sharma
- University of North Dakota, Grand Forks, North Dakota, USA
- Sanford Medical Center Sonography Program, Heart and Vascular Center, Sanford Health, Fargo, North Dakota, USA
| | - Navneet Narula
- Department of Pathology and Laboratory Medicine, New York University Langone Medical Center, New York, New York, USA
| | - Edgar Argulian
- Division of Cardiology, Mount Sinai Morningside Hospital, New York, New York, USA
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Lakhani DA, Balar AB, Kim C. Prominent crista terminalis mimicking a right atrial mass: A case report and brief review of the literature. Radiol Case Rep 2021; 17:434-438. [PMID: 34917223 PMCID: PMC8666457 DOI: 10.1016/j.radcr.2021.11.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 11/30/2022] Open
Abstract
The crista terminalis is a normal anatomical structure, characterized by a smooth muscular ridge along the superior aspect of the right atrium. It is derived from resorption of the right valve of the sinus venosus and it divides the right atrium into smooth posteromedial and trabeculated anterolateral portions. Crista terminalis is not normally detected in the standard views of transthoracic echocardiogram and non-gated CT of the chest. In rare circumstances, the crista terminalis may be prominent and could lead to misdiagnosis as a malignant process, such as in our case. A comprehensive understanding of the crista terminalis anatomy, and its characteristic appearance on transthoracic echocardiogram, CT and PET/CT will minimize the risk of misdiagnosis and will avoid patient anxiety with more extensive examinations. Here, we present a case of a 78-year-old male with newly diagnosed high-grade invasive urinary bladder urothelial carcinoma. Pre-operative transthoracic echocardiogram reported as 2 cm right atrial mass concerning a metastasis lesion. Subsequent evaluation with MRI cardiac morphology confirmed the diagnosis of benign prominent crista terminalis, a normal anatomical structure.
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Stiru O, Dragulescu R, Geana RC, Chibulcutean A, Raducu L, Tulin A, Stroescu AB, Diaconu C, Savu C, Bacalbasa N, Balescu I, Iliescu VA. Catheter-related giant right atrial thrombosis mimicking a myxoma: A case report. Exp Ther Med 2021; 21:603. [PMID: 33936260 DOI: 10.3892/etm.2021.10035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/02/2021] [Indexed: 11/05/2022] Open
Abstract
Despite the development of imagistic methods, the differential diagnosis of a right atrial mass may be difficult to be established, the most common pathologies which should be taken in consideration being represented by thrombus, tumors, prominent crista terminalis, or vegetation of infectious endocarditis. In this study, we present the case of a 63-year-old man with chronic kidney disease, in hemodialysis (HD) with a silicone central venous catheter (CVC) with the incidental transthoracic echocardiography (transthoracic echocardiogram, TTE) finding of a tumoral mass of 35x26 mm in the right atrium (RA), not related with the catheter, which was diagnosed as right atrial myxoma and underwent surgical excision. After reviewing the histopathology probe, the diagnosis of right atrial thrombus was confirmed. In conclusion, differentiating intracardiac right atrial masses (RAMs) could may prove challenging. In our patient, clinical presentation and the preoperative investigations could not differentiate the right atrial thrombus from a myxoma, and only the postoperative histopathology diagnosis was able to guide correct diagnosis.
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Affiliation(s)
- Ovidiu Stiru
- Department of Cardiovascular Surgery, 'Prof. Dr. C. C.' Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania.,Department of Cardiovascular Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Razvan Dragulescu
- Department of Cardiovascular Surgery, 'Prof. Dr. C. C.' Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Roxana Carmen Geana
- Department of Cardiovascular Surgery, 'Prof. Dr. C. C.' Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Andreea Chibulcutean
- Department of Cardiovascular Surgery, 'Prof. Dr. C. C.' Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Laura Raducu
- Department of Plastic and Reconstructive Microsurgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of General Surgery, 'Prof. Dr. Agripa Ionescu', Clinical Emergency Hospital, 011356 Bucharest, Romania
| | - Adrian Tulin
- Department of General Surgery, 'Prof. Dr. Agripa Ionescu', Clinical Emergency Hospital, 011356 Bucharest, Romania.,Department of Anatomy, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Andra Balcangiu Stroescu
- Department of Cardiovascular Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Camelia Diaconu
- Department of Internal Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
| | - Cornel Savu
- Department of Thoracic Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Thoracic Surgery, 'Marius Nasta' National Institute of Pneumology, 050159 Bucharest, Romania
| | - Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'I. Cantacuzino' Clinical Hospital, 030167 Bucharest, Romania.,Department of Visceral Surgery, Center of Excellence in Translational Medicine, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
| | - Irina Balescu
- Department of Surgery, 'Ponderas' Academic Hospital, 021188 Bucharest, Romania
| | - Vlad Anton Iliescu
- Department of Cardiovascular Surgery, 'Prof. Dr. C. C.' Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania.,Department of Cardiovascular Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Manabe O, Oyama-Manabe N, Tamaki N. Positron emission tomography/MRI for cardiac diseases assessment. Br J Radiol 2020; 93:20190836. [PMID: 32023123 DOI: 10.1259/bjr.20190836] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Functional imaging tools have emerged in the last few decades and are increasingly used to assess the function of the human heart in vivo. Positron emission tomography (PET) is used to evaluate myocardial metabolism and blood flow. Magnetic resonance imaging (MRI) is an essential tool for morphological and functional evaluation of the heart. In cardiology, PET is successfully combined with CT for hybrid cardiac imaging. The effective integration of two imaging modalities allows simultaneous data acquisition combining functional, structural and molecular imaging. After PET/CT has been successfully accepted for clinical practices, hybrid PET/MRI is launched. This review elaborates the current evidence of PET/MRI in cardiovascular imaging and its expected clinical applications for a comprehensive assessment of cardiovascular diseases while highlighting the advantages and limitations of this hybrid imaging approach.
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Affiliation(s)
- Osamu Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Noriko Oyama-Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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