Abstract
BackgroundThe crista terminalis is a variation of normal anatomical structure within the right atrium which may be misdiagnosed with an abnormal atrial mass normally visualized in the standard views on the transthoracic echocardiogram.Case presentationIn this case presentation, we demonstrated a rare case report describing the accidental discovery of a right atrial mass-like structure in a 54-year old Asian man without physical discomfort during an echocardiographic examination. These findings naturally caused some concern as the differential diagnosis such as right atrial myxoma or thrombus and further examination were organized. The subsequent positron emission tomography/magnetic resonance imaging (PET/MRI) differentiated a true right atrial mass from a strip extending into the atrium in accordance with prominent crista terminalis.ConclusionA preferable understanding of the complex anatomy and PET/MRI appearance of a prominent crista terminalis will minimize the misdiagnosis of this structure and avoiding unnecessary anxiety and more invasive examinations.
Highlights
The crista terminalis is a variation of normal anatomical structure within the right atrium which may be misdiagnosed with an abnormal atrial mass normally visualized in the standard views on the transthoracic echocardiogram.Case presentation: In this case presentation, we demonstrated a rare case report describing the accidental discovery of a right atrial mass-like structure in a 54-year old Asian man without physical discomfort during an echocardiographic examination
A preferable understanding of the complex anatomy and positron emission tomography/magnetic resonance imaging (PET/MRI) appearance of a prominent crista terminalis will minimize the misdiagnosis of this structure and avoiding unnecessary anxiety and more invasive examinations
Compared with the method in echocardiography, the ability of cardiac positron emission tomography/magnetic resonance imaging (PET/MRI) to tissue characteristics enables differentiation between tumor, thrombus, structural abnormalities and normal variant anatomical structures, which is frequently recommended for further evaluation in presence of an unclear cardiac mass and minimizes the misdiagnosis of
Summary
A prominent crista terminalis is a well-defined fibromuscular ridge formed by the junction of the sinus venosus and primitive right atrium (RA) extending along the posterolateral aspect of the right atrial wall, which is a normal anatomic variant and recognized by echocardiography occasionally [1, 2] This variant structure can be misdiagnosed with true right atrial mass like tumor, thrombus or vegetation [3,4,5,6,7,8,9,10,11]. An apparently smooth mass-like echogenic structure (9*11 mm) attached to tricuspid valve was noted in the right atrium and suggestive of a thrombus or a tumor in four-chamber apical view (Fig. 1).
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