Diagnosis of Left Atrial Appendage Thrombi by Multiplane Transesophageal Echocardiography Interlaboratory Comparative Study

Schneider, B.; Stöllberger, Claudia; Schneider, Barbara

doi:10.1253/circj.71.122

Cited by 28 publications

(16 citation statements)

References 25 publications

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“…Recent studies have reported that the accuracy, 5 interobserver reproducibility, 6 and level of diagnostic confidence 7 associated with evaluation of the LAA for thrombi by 2D TEE are suboptimal. Schneider et al 6 evaluated interlaboratory variability for the diagnosis of LAA thrombi in 50 patients with atrial fibrillation and found that the interpretations of 2 expert observers from 2 different laboratories were discordant in 11 (22%) of the TEE studies.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of a Bilobed Left Atrial Appendage and Pectinate Muscles Mimicking Thrombi on Real-time 3-Dimensional Transesophageal Echocardiography

Willens

Qin

Keith

et al. 2010

Journal of Ultrasound in Medicine

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Objective. Transesophageal echocardiography (TEE)-guided cardioversion is an established strategy for managing atrial arrhythmias and is commonly used as an alternative to the conventional approach of administering several weeks of anticoagulation before cardioversion. However, the safety of this approach depends on the exclusion of left atrial appendage (LAA) thrombi with a high level of diagnostic confidence. The objective of this case series is to explore the use of real-time 3-dimensional (RT3D) TEE in the precardioversion evaluation of patients with complex anatomy in their LAAs. Methods. We used RT3D TEE to further assess the LAAs of 3 patients being evaluated for cardioversion who had inconclusive 2-dimensional (2D) TEE studies because of complex anatomic variants of the LAA. We imaged the LAA using the 3D zoom mode and rotated this image to view the LAA en face from the perspective of its ostium. Further cropping was performed as needed. Results. In all 3 patients, the additional views of the appendage obtained by RT3D TEE were decisive in excluding contraindications to cardioversion. The unique en face view of the LAA acquired with 3D TEE, which was previously unobtainable using 2D TEE, was particularly useful. In 1 patient, a bilobed LAA mimicked a thrombus. In 2 other patients, prominent pectinate muscles masqueraded as thrombi. Conclusions. Three-dimensional TEE is valuable for the precardioversion evaluation of patients with complex anatomic variants of the LAA.

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Section: Discussionmentioning

confidence: 99%

Diagnosis of a Bilobed Left Atrial Appendage and Pectinate Muscles Mimicking Thrombi on Real-time 3-Dimensional Transesophageal Echocardiography

Willens

Qin

Keith

et al. 2010

Journal of Ultrasound in Medicine

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“…8 This is exemplified in multiple case reports, which describe patients undergoing unnecessary sternotomies due to misinterpretation of aortic dissection on echocardiography. 11,12 Moreover, even with multiplane echocardiography, these artifacts significantly increase inter-observer variability in the diagnosis of LAAT. Echocardiography is the method of choice for evaluation of LAAT.…”

Section: Examples Of Simple Reverberation Artifactsmentioning

confidence: 99%

“…9,10 Simple reverberation artifacts are also clinically significant in diagnosing left atrial appendage thrombi (LAAT). 12 If this artifact is not recognized, patients can end up receiving undue anticoagulation therapy or even undue surgery. However, multiple studies have recognized that a significant portion of cases contained reverberation artifacts that were misinterpreted as thrombi.…”

Section: Examples Of Simple Reverberation Artifactsmentioning

confidence: 99%

“…However, multiple studies have recognized that a significant portion of cases contained reverberation artifacts that were misinterpreted as thrombi. 11,12 Moreover, even with multiplane echocardiography, these artifacts significantly increase inter-observer variability in the diagnosis of LAAT. 12 If this artifact is not recognized, patients can end up receiving undue anticoagulation therapy or even undue surgery.…”

Section: Examples Of Simple Reverberation Artifactsmentioning

confidence: 99%

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Ultrasound imaging artifacts: How to recognize them and how to avoid them

Quien

Sarić

2018

Echocardiography

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Echocardiography has become a critical tool in clinical cardiology in evaluating cardiac physiology and diagnosing cardiac disease states. However, imaging artifacts are commonly encountered and often lead to misdiagnoses of life-threatening diseases, such as aortic dissection and ventricular thrombus. It is, thus, critical for clinicians to understand these artifacts to avoid these misdiagnoses and protect patients from undue intervention. Artifacts can be broken down into two categories: those from violation of ultrasound system assumptions and those from interference by external equipment and devices. This review article discusses the most commonly encountered artifacts by category, explains their physical mechanisms, elaborates on their most common presentations, and instructs clinicians on how to avoid their misinterpretation.

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“…Although tranesophageal echocardiography remains the gold standard for the detection of intraatrial thrombi, interobserver variability remains 1 . In one study, in which intraatrial thrombi on transesophageal echocardiography were classified by experienced echocardiographers as definite, questionable, or absent, there was significant interobserver variability with a different conclusion in 11 of 50 cases (κ= 0.5) 2 . Echocontrast has been demonstrated to be useful in differentiating intraatrial smoke from intraatrial thrombus, but not in the case of a pericardial effusion surrounding the left atrium 3 …”

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confidence: 99%

Fibrinous Material in a Pericardial Effusion Mimicking Intraatrial Thrombus

2008

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A 74-year-old woman presented with an acute cerebrovascular infarct involving multiple vascular territories, suggestive of an embolic event. The initial transesophageal images create the impression of an echogenic mass in the left atrial appendage. A small pericardial effusion was also seen surrounding the left atrial appendage. After further views were obtained, the echogenic mass appeared to be in this fluid-filled space rather than in the appendage itself. To confirm this finding, echo contrast (Definity) was administered. After contrast injection, the left atrial appendage was opacified, while the effusion around the appendage and the echodensity within this space were not opacified. Our case highlights the utility of contrast-enhanced echocardiography in clearly delineating the boundaries of the endocardium in cases, when a pericardial effusion surrounds the left atrial appendage.

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Diagnosis of Left Atrial Appendage Thrombi by Multiplane Transesophageal Echocardiography Interlaboratory Comparative Study

Cited by 28 publications

References 25 publications

Diagnosis of a Bilobed Left Atrial Appendage and Pectinate Muscles Mimicking Thrombi on Real-time 3-Dimensional Transesophageal Echocardiography

Diagnosis of a Bilobed Left Atrial Appendage and Pectinate Muscles Mimicking Thrombi on Real-time 3-Dimensional Transesophageal Echocardiography

Ultrasound imaging artifacts: How to recognize them and how to avoid them

Fibrinous Material in a Pericardial Effusion Mimicking Intraatrial Thrombus

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