Incremental Value of Live/Real-Time Three-Dimensional Transesophageal Echocardiography Over the Two-Dimensional Technique in the Identification of Accessory Liver Lobe Presenting as a Right Atrial MassAN ACCESSORY LIVER LOBE is a congenital abnormality of hepatic tissue overgrowth. It is related to embryonic heteroplasia or rarely may occur secondary to trauma or surgery.1 When in direct continuity with the liver, it is termed a “supernumerary liver lobe”, and when completely separate from the liver, it is described as an “ectopic liver lobe”.2 The reported incidence of accessory liver lobes, including Riedel’s lobe, which is the most well-known type seen as a tongue-like protrusion of hepatic segments V and VI, variably is stated as being 3.3%-to-31% in the general population.
Guess the Mass!CASEOUS MITRAL ANNULAR calcification (CMAC) is an uncommon variant of mitral annular calcification. This case demonstrates the need for a high level of clinical suspicion in order to correctly diagnose CMAC, as it could be easily mistaken for an atrial tumor, an abscess, or a vegetation. Making the correct diagnosis of CMAC can facilitate the implementation of appropriate treatment strategies, which could potentially reduce cerebral vascular accidents. Additionally, the use of multimodal imaging in characterizing such intracardiac masses is essential.
Intracardiac Mass of Unknown OriginA 40-YEAR-OLD WOMAN was referred to the authors’ emergency department with symptoms of nausea, vomiting, and sudden onset of right flank pain, which had increased progressively in severity during the 4 days before admission. The patient reported similar symptoms 2 years previously in her left flank that subsided after 2 days. Laboratory evidence of acute kidney injury was present on admission (creatinine 3.95 mg/dL, blood urea nitrogen 36 mg/dL). A computed tomography scan demonstrated renal and splenic hypodensities (Figs 1 and 2).
Mitral Valve Mass Detected on Preoperative Transesophageal EchocardiogramA 45-YEAR-OLD WOMAN with past medical history significant for hypertension, asthma, and anemia was admitted to the authors' institution with complaint of dyspnea on exertion. A preoperative transthoracic echocardiogram showed moderate-to-severe aortic regurgitation, mild dilatation of the sinus of valsalva and ascending aorta and mild decrease in left ventricular function with an ejection fraction equal to 48%. The patient was scheduled for an aortic valve replacement and possible aortic root replacement.
An Unusual Finding After Cardiac TransplantationA 41-YEAR-OLD WOMAN with a history of nonischemic cardiomyopathy was admitted for cardiac transplantation. Seven months previously, a Jarvik left ventricular assist device (Jarvik Heart, Inc, New York, NY) had been implanted as a bridge to transplantation. Other pertinent medical history included an implantable cardioverter-defibrillator, chronic kidney disease, and tobacco abuse. The patient underwent an uneventful anesthetic and surgical course that included left ventricular assist device explantation and an orthotopic cardiac transplantation.
Clinical Utility of Intraoperative 2D and 3D Transesophageal Echocardiography in the Assessment of a Left Atrial Mass During PneumonectomyA PATIENT PRESENTING for thoracotomy for the diagnosis and management of a left upper-lobe mass and an intracardiac mass is described. Transesophageal echocardiography (TEE) was used to assess intracardiac tumor position, size, and mobility. In addition, the surgical removal of the tumor from the left atrium was guided by TEE, which also was used to confirm complete surgical resection.
CASE 3—2010 Dynamic Partial Obstruction of the Tricuspid Valve Inlet Produced by Anterior Mediastinal Aspergillosis Invading the Right AtriumINVASIVE PULMONARY INFECTIONS caused by the opportunistic fungus Aspergillus fumigatus are common in immunocompromised patients and are notoriously difficult to treat successfully.1-4 Such infections frequently are encountered after solid organ or bone marrow transplantation5,6 and may also occur in patients with severe acquired immunodeficiency syndrome7 or those receiving chronic corticosteroid therapy for other indications.8 Primary cardiac aspergillosis or the spread of invasive pulmonary A fumigatus to the mediastinum, pericardium, or heart is exceedingly rare in the absence of previous cardiac surgery and carries a very high mortality rate.
Real-Time Three-Dimensional Transesophageal Echocardiographic Imaging of Endomyocardial FibrosisTHE FIRST CASE OF real-time 3-dimensional (3D) transesophageal echocardiography (TEE) imaging of an intracardiac mass is reported. Histologic examination later confirmed the diagnosis of endomyocardial fibrosis (EMF). The utilization of real-time 3D imaging to improve the understanding of the precise anatomic location and the dynamic relationship between this rare intracardiac mass and the surrounding anatomic structures during the cardiac cycle is described. Additionally, a brief review of EMF is provided.