Prominent Crista Terminalis Research Articles

PROMINENT CRISTA TERMINALIS AND ATRIAL FLUTTER: CASE REPORT

Abstract Introduction Crista terminalis is a fibromuscular ridge at the posterolateral region of the right atrium (RA). Prominent crista terminalis can mimic pathologic RA mass on transthoracic echocardiograms. Transesophageal echocardiography can be used to differentiate non pathologic structures from pathologic ones. Case Report A 51–year–old men was referred to our clinic with typical atrial flutter. Transthoracic echocardiogram (TTE) revealed a RA mass. It was round, 15 mm in diameter, immobile, not calcified, and located at the posterior region of RA. Transesophageal echocardiography (TEE) showed prominent crista terminalis superiorly located beneath superior vena cava in the RA at 91 degrees midesophageal position. The patient undergoes catheter ablation for typical atrial flutter. Discussion Several congenital structures and normal variants such as Chiari’s network, eustachian and thebesian valves, and atrial septal aneurysms may simulate pathologic RA masses such as RA thrombus or myxomas. However, in this case, an anatomical variant is associated with an arrhythmia that requires treatment. Conclusion In this case we want to emphasize that prominent crista terminalis can mimic RA mass and may lead to atrial arrhythmias. TEE can be used to differentiate normal structures from pathologic.

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

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.

Prominent Crista Terminalis Magnetic Resonance Imaging Findings

Purpose: Prominent Crista Terminalis (PCT) is a frequent variation of the right atrium (RA) posterior wall with a pseudotumor image. The aim of this study is to evaluate PCT image characteristics and cardiac functional effects with cardiac magnetic resonance imaging (CMR).
 Methods: Between 2016 and 2020, 140 patients (58 ±14 years) were evaluated retrospectively. PCT was measured in 2 planes with the longest thickness at the atrial end-diastole. Patients with crista terminalis thickness greater than 8 mm were evaluated. Patients were assessed by the RA, right ventricular (RV) end-diastolic diameter (ED), RV, left ventriculi (LV) ejection fraction (EF), and PCT diameter were included in the study. After the Kolmogorov-Smirnov normality test, cases were compared with the paired student t-test. Mann-Whitney test was used for comparison of non-parametric variables. The effect of the increase in PCT diameter on the RVEF, LVEF, and RAED, RVED was investigated using Pearson's correlation coefficient.
 Results: There was no significant correlation (r

Cyanosis in atrial septal defect with prominent crista terminalis

Right-to-left shunt in atrial septal defect without pulmonary hypertension is a rare condition and can present with complications such as cyanosis. This is a rare case of cyanosis caused by right-to-left shunt atrial septal defect related to prominent crista terminalis.

Catheter-related giant right atrial thrombosis mimicking a myxoma: A case report.

Despite the development of imagistic methods, the differential diagnosis of a right atrial mass may be difficult to be established, the most common pathologies which should be taken in consideration being represented by thrombus, tumors, prominent crista terminalis, or vegetation of infectious endocarditis. In this study, we present the case of a 63-year-old man with chronic kidney disease, in hemodialysis (HD) with a silicone central venous catheter (CVC) with the incidental transthoracic echocardiography (transthoracic echocardiogram, TTE) finding of a tumoral mass of 35x26 mm in the right atrium (RA), not related with the catheter, which was diagnosed as right atrial myxoma and underwent surgical excision. After reviewing the histopathology probe, the diagnosis of right atrial thrombus was confirmed. In conclusion, differentiating intracardiac right atrial masses (RAMs) could may prove challenging. In our patient, clinical presentation and the preoperative investigations could not differentiate the right atrial thrombus from a myxoma, and only the postoperative histopathology diagnosis was able to guide correct diagnosis.

An Intriguing Right Atrial Object in a Child With Ventricular Septal Defect

A nine-month-old-boy (weight, 5.8 kg; height, 70 cm) was taken to the operating room for surgical repair of a ventricular septal defect. Transthoracic echocardiography reported situs solitus (S,D,S) with atrioventricular and ventriculoarterial concordance, a moderate-size (8 mm) perimembranous ventricular septal defect with left-to-right shunt (pressure gradient: 60 mmHg), a dilated left atrium (left atrial indexed diameter Z-score: 2.07, left atrium/aorta ratio: 2.5 and left atrial volume index: 40 mL/m2), and left ventricle with a normal-sized coronary sinus (Fig 1). The midesophageal aortic valve short-axis view by transesophageal echocardiography revealed a circular structure in the right atrium adjacent to the superior aspect of the interatrial septum (white arrow, Fig 2, video clip 1). Following the forward rotation of the transducer angle to about 30°, the structure was slightly elongated (Fig 3). Slight retroflexion of the probe in the midesophageal four-chamber view revealed a normal-sized coronary sinus that appeared separate from the structure (Fig 4, video clip 2). The midesophageal bicaval view showed a prominent crista terminalis (white arrow) (Fig 5). Agitated saline was injected into the left upper arm vein and the contrast was found to enter the right atrium after opacifying the saccular structure (Fig 6, video clip 3). In the midesophageal bicaval view, the agitated saline entered the right atrium and there was no communication with the left atrium (Fig 7, video clip 4). Agitated saline contrast injected into the distal lumen of the central venous catheter demonstrated the contrast in the right atrium without opacification of the right atrial structure (Fig 8, video clip 5). What is this structure? Fig 2The midesophageal aortic valve short-axis view by transesophageal echocardiography revealed a circular structure in the right atrium (white arrows). View Large Image Figure Viewer Download Hi-res image Fig 3The midesophageal aortic valve short-axis view by transesophageal echocardiography with transducer plane rotated to 30° showing the saccular structure. View Large Image Figure Viewer Download Hi-res image Fig 4The midesophageal four-chamber view by transesophageal echocardiography showing the coronary sinus in the usual position. View Large Image Figure Viewer Download Hi-res image Fig 5The midesophageal bicaval view by transesophageal echocardiography displaying a prominent crista terminalis View Large Image Figure Viewer Download Hi-res image Fig 6The midesophageal aortic valve short-axis view by transesophageal echocardiography demonstrating opacification of the saccular structure following injection of agitated saline into the left upper arm vein. View Large Image Figure Viewer Download Hi-res image Fig 7The midesophageal bicaval view by transesophageal echocardiography, showing the agitated saline entering the right atrium and with no communication with the left atrium. View Large Image Figure Viewer Download Hi-res image Fig 8The midesophageal aortic valve short-axis transesophageal echocardiography view showing the agitated saline contrast injected into the distal lumen of the central venous catheter did not opacify the right atrial structure. View Large Image Figure Viewer Download Hi-res image

An unusual presentation of prominent crista terminalis mimicking a right atrial mass: a case report

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.

Cardiovascular Imaging of Prominent Crista Terminalis

The differential diagnosis of intracardiac masses that involves the right atrial chamber include vegetation, thrombus or tumours, and anatomic normal variants such as crista terminalis. Size, shape,location, mobility and attachment of the mass combined with the clinical findings help differentiate etiology. Two Dimensional Trans Thoracic Echocardiography (TTE) became the gold standard test for the diagnosis of intracardiac masses and further examination such as transesophagealechocardiography (TEE) and Cardiac Magnetic Resonance (CMR) improved the accuracy. The cardiovascular imaging is crucial to establish a correct diagnosis for proper management and therapy. Here the author describes the case report of a healthy middle-aged athlete who underwent echocardiography for sports preparticipation screening which detected the presence of a peduncolated right atrial mass of uncertain nature. Because of the strong suspicion for small right atrial mixoma, he underwent CMR that showed a small enhancing mass adherent to the right atrial posterior wall typical of prominent crista terminalis. This report of rare Crista Terminalis muscular bridge that mimicks right atrial mixoma gives new information for the understanding of the aspect of complex and strange right atrial anatomy

THE ROLE OF CMR IMAGING FOR THE DIFFERENTIAL DIAGNOSIS OF RIGHT-SIDED INTRACARDIAC MASSES: A CASE REPORT

Materials and methods: intracardiac masses are described as abnormal structures inside the heart or immediately concerned to the heart [1] and can be classified as a cardiac tumor, metastasis, ,,thrombus in situ”/,,embolus in transit”, vegetation or iatrogenic material [2, 3]. The precise diagnosis is essential due to the necessity of the expedient well-timed treatment. We report a case of 58 year old woman with recently diagnosed left lung adenocarcinoma, admitted to the emergency department with pulmonary embolism. The case report presented here describes the findings of transthoracical echocardiography that suggested a right atrial mass – thrombus versus embolus. However, the subsequent CMR imaging helped to differentiate a true right atrial mass from a prominent crista terminalis. Conclusions: the cardiovascular magnetic resonance imaging is a valuable diagnostic method for the differentiation of the intracardiac masses when the transthoracical and/or transesophagial echocardiography is inadequate in some clinical cases. This noninvasive, cost-effective imaging technique has a larger field of view and differentiates various conditions of the heart therefore the expedient well-timed treatment could be applied.

The importance of prominent crista terminalis after cardiac surgery

The importance of prominent crista terminalis after cardiac surgery

A prominent crista terminalis associated with atrial septal aneurysm that mimics right atrial mass leading to atrial arrhythmias: a case report

IntroductionThe crista terminalis is a variant of normal anatomical structures within the right atrium that mimics an atrial mass on a transthoracic echocardiogram. Atrial septal aneurysm is a rare but well-recognized cardiac abnormality of uncertain clinical significance. The association between crista terminalis and atrial septal aneurysm is unusual but not completely casual. Both anatomical heart structures can lead to atrial arrhythmias.Case presentationThis case report describes the accidental discovery during an echocardiographic examination of a 64-year-old Caucasian woman who had a left bundle branch block and palpitations.ConclusionThe clinical relevance of this anatomical evidence in unknown. This was an occasional finding of transthoracic echocardiography, but in this case it is possible to assume its relationship with the occurrence of atrial arrhythmias, and also that computed tomography scan and cardiovascular magnetic resonance is mandatory to define the structure and function of these incidental findings.

Typical Cardiac MRI Findings of a Prominent Crista Terminalis Mimicking a Right Atrial Mass on Echocardiography

Right atrial masses are frequently identified by echocardiography, which usually represent variant anatomic structures, a tumor or a thrombus. Currently, patients are frequently referred to cardiac magnetic resonance for further evaluation in presence of an unclear cardiac mass on echocardiography. We report a case of a misinterpreted prominent crista terminalis on echocardiography, which demonstrates the strength of multiplanar imaging of cardiac MRI for understanding of the complex anatomy of the heart and its anatomical variations.

Another right atrial pitfall: prominent crista terminalis and atrial septal aneurism

Abstract The case of as yet undescribed combined prominent Crista Terminalis and atrial septal aneurism is presented. The association, due to the complex embryogenesis of the two structures- fossa ovalis and Crista Terminalis, sharing partly common origin, may not be casual. The clinical relevance of the association is unknown, in fact it was an occasional finding of echocardiography, but arguably there could be a tendency to atrial repetitive arrhythmias and a somewhat increased thromboembolic risk. Cardiac Magnetic Resonance can completely elucidate cases such as this one, clearly showing location, morphology, mobility and tissue characters (eg lipid or water content) of cardiac masses.

How to Differentiate Benign versus Malignant Cardiac and Paracardiac18F FDG Uptake at Oncologic PET/CT

Patients undergoing 2-[fluorine 18]fluoro-2-deoxy-d-glucose (FDG) whole-body oncologic positron emission tomography (PET)/computed tomography (CT) are studied while fasting. Cardiac FDG uptake in fasted patients has been widely reported as variable. It is important to understand the normal patterns of cardiac FDG activity that can be seen in oncologic FDG PET/CT studies. These include focal and regional patterns of increased FDG myocardial activity. Focal activity can be observed in papillary muscles, the atria, the base, and the distal anteroapical region of the left ventricle. Regional increased cardiac FDG activity may be diffuse or localized in the posterolateral wall or the base of the left ventricle. Abnormal patterns of cardiac FDG activity not related to malignancy include those associated with lipomatous hypertrophy of the interatrial septum, epicardial and pericardial fat, increased atrial activity associated with atrial fibrillation or a prominent crista terminalis, cardiac sarcoidosis, endocarditis, myocarditis, and pericarditis. Knowledge of these patterns of cardiac FDG activity is important to be able to recognize malignant disease involving the paracardiac spaces, myocardium, and pericardium. With a better understanding of the range of normal and abnormal patterns of cardiac FDG activity, important benign and malignant diseases involving the heart and pericardium can be recognized and diagnosed.

Prominent Crista Terminalis in Patients with Embolic Events

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.

Prominent crista terminalis mimicking a right atrial mass: case report

The crista terminalis is a normal anatomical structure within the right atrium that is not normally visualised in the standard views obtained while performing a transthoracic echocardiogram. In this case report, transthoracic echocardiography suggested the presence of a right atrial mass in a patient with end stage renal disease. However, subsequent transesophageal echocardiography revealed that the right atrial mass was actually a thick muscular bridge in the right atrium consistent with a prominent crista terminalis. An understanding of the anatomy and the echocardiographic appearance of a prominent crista terminalis will minimize the misdiagnosis of this structure avoiding unnecessary expensive additional tests.

Crista terminalis bridge: a rare variant mimicking right atrial mass

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.

Prominent Crista Terminalis: As An Anatomic Structure Leading to Atrial Arrhythmias and Mimicking Right Atrial Mass

Crista terminalis is a fibromuscular ridge at the posterolateral region of the right atrium (RA). Superiorly localized prominent crista terminalis can mimic pathologic RA mass on transthoracic echocardiograms. Transesophageal echocardiography can be used to differentiate nonpathologic structures from pathologic ones. Besides mimicking RA mass, crista terminalis is an important anatomic structure responsible for paroxysmal atrial fibrillation and atrial flutter by initiating ectopic atrial beats. In this case we discuss a patient with atrial arrhythmias who had prominent crista terminalis misdiagnosed as RA mass.

Prominent crista terminalis and Eustachian ridge in the right atrium: Two dimensional (2D) and three dimensional (3D) imaging

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.

Prominent crista terminalis appearing as a right atrial mass on transthoracic echocardiogram

The crista terminalis is a fibromuscular ridge formed by the junction of the sinus venosus and primitive right atrium. In these case reports, transthoracic echocardiography suggested the presence of a right atrial mass. However, subsequent transesophageal echocardiography revealed that the “right atrial mass” was actually a prominent crista terminalis. An understanding of the anatomy and the echocardiographic appearance of a prominent crista terminalis will minimize the misdiagnosis of this structure. (J Am Soc Echocardiogr 2002;15:753-5.)