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      Prominent Crista Terminalis in Patients with Embolic Events

      case-report

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          Abstract

          A prominent crista terminalis is a normal anatomic variant which consist of thick muscular bridge within the right atrium. However, it could be often misdiagnosed with an abnormal mass on the transthoracic echocardiography. The case report presented here, describe the findings of transthoracic echocardiography that suggested a right atrial mass in patients with pulmonary embolism. However, subsequent transesophageal echocardiography and cardiac computed tomography/magnetic resonance imaging differentiated a true right atrial mass from a prominent crista terminalis.

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          Crista terminalis bridge: a rare variant mimicking right atrial mass.

          C. D'Agostino, Nicola D'Amato, Osvaldo Pierfelice (2009)
          Prominent crista terminalis is a variant of normal heart anatomy mimicking right atrial mass-like tumour, thrombus, or vegetation. The case report depicts a rare kind of this structure that constitutes a thick muscular bridge in the right atrium. Detection by 2D and 3D echocardiography can avoid further useless investigation.
          Article 0 comments Cited 8 times – based on 0 reviews     Review now
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            Prominent crista terminalis and Eustachian ridge in the right atrium: Two dimensional (2D) and three dimensional (3D) imaging.

            Liza Thomas, T. McKay (2007)
            The crista terminalis and Eustachian ridge are normal anatomical structures within the right atrium that are not normally looked for or visualised in the standard views obtained while performing a transthoracic echocardiogram (TTE). In this case report, the prominent terminal ridge (a normal anatomical variant) appeared as a "mass" in the right atrium that needed to be differentiated from a pathological cardiac mass. Identification of physiological structures in the right atrium on TTE using additional 3D imaging can avoid unnecessary additional tests that are both more invasive and expensive such as transesophageal echocardiography or MRIs.
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              Prominent crista terminalis mimicking a right atrial mixoma: cardiac magnetic resonance aspects.

              C Gaudio, S Di Michele, M Cera … (2015)
              A 68-year-old woman came to our observation with a clinical history of isolated systolic hypertension poorly controlled by the combination of ramipril 5 mg and hydrochlorothiazide 12.5 mg o.d. The ECG showed sinus rhythm with heart rate of 68 beats per minute and signs of left ventricular hypertrophy without strain. Further investigation included an echocardiogram that showed normal left and right cavities and normal cardiac valves. At the level of the posterior wall of the right atrial (RA) an apparent smooth, bean-like tumor, having a thin pedicle, was identified as a RA mixoma. Cardiac MRI was requested and showed in two sequential slices a muscular ridge, identified as a prominent crista terminalis. Some para-physiological structures sited in the RA may have the appearance of tumors, as crista terminalis, Eustachian valve extending into the RA chambers and Chiari network. The multiplain projections of MRI allow the cardiologist to identify the presence of intracardiac masses and to make a differential diagnosis between neoplasms and variant anatomic structures.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Cardiovasc Ultrasound
                Journal ID (publisher-id): JCU
                Title: Journal of Cardiovascular Ultrasound
                Publisher: Korean Society of Echocardiography
                ISSN (Print): 1975-4612
                ISSN (Electronic): 2005-9655
                Publication date (Print): September 2011
                Publication date (Electronic): 30 September 2011
                Volume: 19
                Issue: 3
                Pages: 156-158
                Affiliations
                [1 ]Cardiovascular Center, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
                [2 ]Cardiothoracic Division, Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
                Author notes
                Address for Correspondence: Eung Ju Kim, Cardiovascular Center, Korea University Guro Hospital, 97 Gurodong-gil, Guro-gu, Seoul 152-703, Korea. Tel: +82-2-2626-3021, Fax: +82-2-867-9093, withnoel@ 123456hanmail.net
                Article
                DOI: 10.4250/jcu.2011.19.3.156
                PMC ID: 3209597
                PubMed ID: 22073328
                SO-VID: b4032db8-bedc-4cd4-9838-c17e0c8cbb22
                Copyright © Copyright © 2011 Korean Society of Echocardiography
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 18 March 2011
                Date revision received : 09 June 2011
                Date accepted : 17 August 2011
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: right atrial mass,crista terminalis
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: right atrial mass, crista terminalis

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