Prominent crista terminalis mimicking a right atrial mass: case report

Abstract

The crista terminalis is a normal anatomical structure within the right atrium that is not normally visualised in the standard views obtained while performing a transthoracic echocardiogram. In this case report, transthoracic echocardiography suggested the presence of a right atrial mass in a patient with end stage renal disease. However, subsequent transesophageal echocardiography revealed that the right atrial mass was actually a thick muscular bridge in the right atrium consistent with a prominent crista terminalis. An understanding of the anatomy and the echocardiographic appearance of a prominent crista terminalis will minimize the misdiagnosis of this structure avoiding unnecessary expensive additional tests.

Intrinsic and Extrinsic Cardiac Pseudotumors: Echocardiographic Evaluation and Review of the Literature

“…It separates the smooth‐walled posterior right atrium from the trabeculated and muscular anterior right atrium and right atrial appendage. The thickness of the crista varies widely in adults ranging usually from 3 to 6 mm and depends on the degree of regression . If the crista is seen on TTE, it is generally manifested as an echodense linear ridge extending laterally from the atrial septum and located on the posterior portion of the right atrial wall.…”

“…The crista terminalis is a "twisted" C-shaped, fibromuscular ridge that runs along the posterolateral free wall of the right atrium as it passes anterior to the superior vena cava (SVC) and to the right side of the orifice of the inferior vena cava. [60][61][62] It separates the smooth-walled posterior right atrium from the trabeculated and muscular anterior right atrium and right atrial appendage. The thickness of the crista varies widely in adults ranging usually from 3 to 6 mm and depends on the degree of regression.…”

“…The thickness of the crista varies widely in adults ranging usually from 3 to 6 mm and depends on the degree of regression. 60 If the crista is seen on TTE, it is generally manifested as an echodense linear ridge extending laterally from the atrial septum and located on the posterior portion of the right atrial wall. The crista is quite often mistaken for a right atrial mass.…”

When is a mass not a mass? An unusual presentation of prominent crista terminalis

“…The crista terminalis is a fibromuscular ridge formed by the junction of the sinus venosus and primitive right atrium 1. It extends along the posterolateral aspect of the right atrial wall.…”

Morphological pattern of Crista terminalis, Musculi pectinati and Taenia sagittalis with applied significance

“…The echocardiographic finding of a prominent crista terminalis can mimic a right atrial mass, such as a tumor or thrombus (D'AMATO, PIERFELICE and D'AGOSTINO, 2009;GAUDIO, DI MICHELE, CERA et al, 2004). Thus, an understanding of the anatomy and proper identification helps in avoiding misdiagnosis (SALUSTRI, BAKIR, SANA et al, 2010). Taking into consideration that only few studies are there to analyze the gross features of MP in relation to CT, this study was planned and executed to describe the morphologic patterns of the MP and TS (LOUKAS, TUBBS, TONGSON et al, 2008).…”