The appearance is caused by fatty infiltration of the atrial septum with sparing of the fossa ovalis ( Fig. The characteristic “dumbbell” shape seen in the ME four-chamber or ME bicaval view differentiates lipomatous hypertrophy from other structures. Lipomatous hypertrophy of the atrial septum can mimic atrial masses such as myxomas. Myxomas, the most common cardiac tumors, often originate from the interatrial septum and typically involve the fossa ovalis. Lipomatous Hypertrophy of the Atrial Septum They are best visualized in the ME bicaval view, in which they can be seen originating from the junction of the right atrium and inferior vena cava ( Fig. The filamentous structures can be differentiated from thrombus by their characteristic “insertion” into the atrial wall. The Eustachian valve (called a Chiari network when fenestrated) is the remnant of the embryologic right venous valve, which is important in utero to direct inferior vena cava blood flow across the fossa ovalis. The Eustachian valve is often misdiagnosed as an intra-atrial thrombus.

The structure is best visualized in the midesophageal (ME) bicaval view ( Fig. The crista terminalis separates the trabeculated appendage of the atrium from the smooth tubular portion. The crista terminalis originates at the junction of the right atrium and superior vena cava and runs longitudinally toward the inferior vena cava. This prominent muscular ridge can be differentiated from an anomaly by its characteristic appearance and position. The crista terminalis has been misinterpreted as a right atrial tumor or thrombus. Careful evaluation and a consideration of the common variants discussed in the subsequent text can help limit problems related to misdiagnosis. These normal variants can affect the intraoperative diagnosis and lead to an inappropriate surgery, which can have a devastating impact on the outcome. NORMAL ANATOMIC VARIANTS IN TWO-DIMENSIONAL IMAGINGīoth novice and experienced echocardiographers may call normal structures abnormal. Second, we discuss the artifacts commonly encountered in two-dimensional imaging and three-dimensional imaging, and finally, we discuss the artifacts commonly encountered in Doppler examinations. In this chapter we first review the common false interpretations of normal anatomy. The most common artifacts seen in clinical practice are the result of (a) normal or variant anatomic structures that are misdiagnosed, (b) the physical limitations of ultrasound imaging, and (c) undesirable interactions of ultrasound with tissues or medical devices. Knowledge of the types of artifacts that occur during a standard TEE examination is of paramount importance for the correct interpretation of the echo data. Perrino, Jr.Ĭ LINICALLY IMPORTANT IMAGING ARTIFACTS RESULT from the interplay of the ultrasound system, the patient, and the interpreting echocardiographer.

Common Artifacts and Pitfalls of Clinical Echocardiographyįabio Guarracino and Albert C.

Prominent lung artifact meaning