Both ex 3D and en 3D reconstructions of MRA precisely visualize the complex LA anatomy. Exact determination of PV ostial geometry is facilitated with en 3D and provides important anatomical information for the PVI strategy. According to our data, individual encircling of every PV is strongly discouraged.

Objective: Thresholds of 2-20 hounsfield units (HU) in unenhanced computed tomography (CT) are suggested to discriminate benign adrenal tumors (BATs) from malignant adrenal tumors. However, these studies included only low numbers of adrenocortical carcinomas (ACCs). This study defines a HU threshold by inclusion of a large cohort of ACCs. Design: Retrospective, blinded, comparative analysis of CT scans from 51 patients with ACCs (30 females, median age 49 years) and 25 patients with BATs (12 females, median age 64 years) diagnosed during the period of 2005-2010 was performed. Methods: Tumor density was evaluated in unenhanced CT by two blinded investigators. Results: Median tumor size was 9 cm (range 2.0-20) for ACCs vs 4 cm (2.0-7.5) for BATs (P!0.0001). In ACCs, the median unenhanced HU value was 34 (range 14-74) in comparison with 5 (K13 to 40) in BATs (P!0.0001). ROC analysis revealed a HU of 21 as threshold with the best diagnostic accuracy (sensitivity 96%, specificity 80%, and AUC 0.89). However, two ACCs that were 5 and 6 cm in size would have been missed. Setting the threshold to 13.9 allowed for 100% sensitivity, but a lower specificity of 68%. Conclusions: This first large study on ACCs confirmed that the vast majority of ACCs have unenhanced HU O21. However, to avoid misdiagnosing an ACC as benign, a threshold of 13 should be used.

TEE can be used as a follow-up tool after interventional therapy in patients after catheter ablation and acquired PVS/PVO. Restenosis/in-stent restenosis can be identified by analyzing the vessel diameters and blood flow characteristics.

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The case of a 78-year-old female patient who suffered atrial fibrillation and persistent thrombus in the left atrial appendage despite sufficient anticoagulation is reported. The case is chosen to demonstrate the complexity inherent in prophylaxis as well as risk evaluation of thromboembolism on the basis of clinical and echocardiographic criteria. We also discuss transesophageal echocardiography as the standard diagnostic procedure for detection of intracardiac thrombi prior to cardioversion as well as cardiac computer tomography as an alternative.