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

Salim, Handi; Palit, Amitabh; Maher, Anthony D.

doi:10.1136/bcr-2015-211532

Cited by 5 publications

(2 citation statements)

References 10 publications

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“…During TEE examination, in particular, the mid-esophageal bicaval view may be the best way to visualize the crista terminalis (6,39). However, currently in the presence of an unclear cardiac mass on echocardiography, patients are usually referred to CMR for further evaluation (16)(17)(18). On CMR studies, the crista terminalis is described as the structure connected to the RA and the right atrial auricle, which has a similar signal intensity to the myocardium, and does not show enhancement after contrast injection (1).…”

Section: Discussionmentioning

confidence: 99%

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Prominent crista terminalis mimicking a right atrial mass: a systematic literature review and meta-analysis

Matusik,

Mikrut,

Bryll

et al. 2024

Acta Radiol

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The crista terminalis is an anatomical structure localized on the posterolateral wall of the right atrium (RA). We performed a systematic review of the literature and meta-analysis concerning cases of unusual prominent crista terminalis mimicking RA mass. Moreover, we described the differential diagnosis of cardiac masses with the use of echocardiography, computed tomography, and cardiac magnetic resonance (CMR). We also emphasize the potential importance of this structure in electrophysiological procedures, including its role in exaggerated arrhythmias. Prominent crista terminalis may be a potential obstacle during invasive cardiac procedures or catheter ablation target. In analyzed cases, the crista terminalis was often erroneously interpreted as pathologic and at first confused with a thrombus or tumor during transthoracic echocardiography examination. The correct final diagnoses were mostly made with used transesophageal echocardiography or CMR. The most important imaging findings suggestive of prominent crista terminalis rather than tumor were a similar echogenicity/intensity with adjacent myocardium, the location on posterolateral wall of the RA, the phasic change in size, and no enhancement after contrast injection. We describe up to date and detailed imaging features for the differential diagnostics of selected intracardiac masses using various imaging techniques, including multimodality cardiac imaging. Familiarity with the anatomy and the imaging findings of the prominent crista terminalis will reduce misdiagnosis and avoid additional tests and unwarranted clinical interventions, while in patients considered for invasive cardiac procedures it might increase their efficacy and safety.

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Section: Discussionmentioning

confidence: 99%

“…A 32-year-old female competitive athlete diagnosed with paroxysmal atrial fibrillation was presented by Salim et al (16). She complained of palpitations and occasional episodes of dizziness.…”

Section: Studies Using Advanced Imaging Modalities In the Diagnostic ...mentioning

confidence: 99%

Prominent crista terminalis mimicking a right atrial mass: a systematic literature review and meta-analysis

Matusik,

Mikrut,

Bryll

et al. 2024

Acta Radiol

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Normal Variants in Echocardiography

Sanchez

Bryg

2016

Curr Cardiol Rep

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Echocardiography is a powerful and convenient tool used routinely in the cardiac evaluation of many patients. Improved resolution and visualization of cardiac anatomy has led to the discovery of many normal variant structures that have no known pathologic consequence. Importantly, these findings may masquerade as pathology prompting unnecessary further evaluation at the expense of anxiety, cost, or potential harm. This review provides an updated and comprehensive collection of normal anatomic variants on both transthoracic and transesophageal imaging.

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Prominent crista terminalis mimicking a right atrial mass: A case report and brief review of the literature

Lakhani

Balar

Kim

2022

Radiology Case Reports

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The crista terminalis is a normal anatomical structure, characterized by a smooth muscular ridge along the superior aspect of the right atrium. It is derived from resorption of the right valve of the sinus venosus and it divides the right atrium into smooth posteromedial and trabeculated anterolateral portions. Crista terminalis is not normally detected in the standard views of transthoracic echocardiogram and non-gated CT of the chest. In rare circumstances, the crista terminalis may be prominent and could lead to misdiagnosis as a malignant process, such as in our case. A comprehensive understanding of the crista terminalis anatomy, and its characteristic appearance on transthoracic echocardiogram, CT and PET/CT will minimize the risk of misdiagnosis and will avoid patient anxiety with more extensive examinations. Here, we present a case of a 78-year-old male with newly diagnosed high-grade invasive urinary bladder urothelial carcinoma. Pre-operative transthoracic echocardiogram reported as 2 cm right atrial mass concerning a metastasis lesion. Subsequent evaluation with MRI cardiac morphology confirmed the diagnosis of benign prominent crista terminalis, a normal anatomical structure.

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

Cited by 5 publications

References 10 publications

Prominent crista terminalis mimicking a right atrial mass: a systematic literature review and meta-analysis

Prominent crista terminalis mimicking a right atrial mass: a systematic literature review and meta-analysis

Normal Variants in Echocardiography

Prominent crista terminalis mimicking a right atrial mass: A case report and brief review of the literature

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