Two-dimensional echocardiography in the diagnosis of intracardiac masses: A prospective study with anatomic validation

Abstract

The accuracy of two-dimensional echocardiography in the detection of intracardiac masses was verified in 334 patients who underwent cardiac catheterization in our laboratory over 21 consecutive months. A complete two-dimensional echocardiographic (2DE) examination was performed a day before catheterization. The presence or absence of a mass was verified at surgery in 77 patients who successively underwent mitral or aortic valve replacement (51), left ventricular aneurysmectomy with or without myocardial revascularization (25), and resection of atrial myxoma (2). In 32 patients 2DE revealed the presence of a mass-left or right atrial thrombi in 12, left atrial myxoma in 2, left ventricular thrombi in 16, and endocardial vegetations in 2. The other 45 patients were free of intracardiac masses on 2DE. Anatomic verification at surgery revealed the presence of an intracardiac mass in 34 patients. In 30 (true positives) of these, 2DE revealed the mass as well, and in 4 (false negatives) the presence of a mass had not been identified by 2DE. In 2 patients (false positives) the predicted mass was not found at surgery. Absence of a mass was correctly predicted by 2DE in 41 patients (true negatives). Thus 2DE detected intracardiac masses with sensitivity of 88.2% and a specificity of 95.3%. We recommend that 2DE be performed in all patients prior to hemodynamic study and/or cardiac surgery to enable safer management of patients with intracardiac masses during cardiac catheterization and/or cardiac surgery.

Catheter-related atrial thrombus: tip of the iceberg?

“…27,28 Sheiban et al reported that two-dimensional echocardiography has an 82.2% sensitivity and 95.3% specificity in detection of intracardiac masses. 29 Our study shows more common atrial thrombus among female and diabetic patients compared to male and nondiabetic patients, but there were not any statistical significance probably due to limited number of the patients. Stavroulopoulos et al also reported higher frequency of atrial thrombus in female patients.…”

Arterial Thrombosis at High Altitude Resulting in Loss of Limb

“…The compression technique we used has greater than 90% sensitivity for proximal DVT and approximately 50% sensitivity for distal DVT (Jang et al, 2004;Goodacre et al, 2005). After finding no evidence of DVT, we performed an echochardiogram to assess for intracardiac thrombus or mass and more definitively rule out atrial fibrillation, other likely sources of thromboembolism that can be identified using two-dimensional ultrasound (Abbott et al, 1982;Sheiban et al, 1987). We did not pursue the possible presence of a patent foramen ovale by injection of air contrast since we had not identified a DVT and had little experience with the technique.…”

How to manage catheter-related right atrial thrombosis: Our conservative approach

“…18 TTE examinations, using apical four-chamber and subcostal views, can be used as a screening tool with sensitivity and specificity of 82.2% and 95.3%, respectively. 19 Furthermore, magnetic resonance imaging and CT scans have been used to detect intracardiac thrombi. On the one hand, catheter removal may prevent CRAT relapses, thromboembolism, and septic complications.…”