zyxw zyxw Left Atrial Pseudomass by Transthoracic Echocardiography THEODORE R. ADDAI, M.D., and JAMES L. POTTS, M.D. Department of Medicine, Meharry Medical College, Nashville, Tennessee left atrial pseudomass, transthoracic echocardiography zyxw We present two cases of left atrial pseudomasses seen on transthoracic echocardiography (TTE). In both cases, TTE was performed with an Acuson Sequoia 256 system. view (Fig. 3) demonstrates LA pseudomass. PV flow adjacent to the pseudomass is shown in Figure 4. A pseudomass was also seen in the four-chamber view. Case Reports Results and Discussion Case 1 An 87-year-old man presented with cardiac amyloidosis and congestive heart failure. His four-chamber view showing the left ventricle (LV),left atrium (LA), right ventricle (RV),and right atrium (RA) from TTE is given in Figure 1and has the appearance of a left atrial mass. An anteriorly angulated view is shown in Figure 2; it can be seen that this mass is attached by a thin pedicle and is positioned in the area of the normal tissue ridge that separates the left atrial appendage (LAA) from the pulmonary vein (PV). In real-time, the LAA showed active contraction. Case 2 A 20-year-old man presented with peritonsillar abscess. A modified parasternal long-axis Address for correspondence and reprint requests: Theodore Rexford Addai, M.D., Department of Medicine, Meharry Medical College, 1005 D. B. Todd Boulevard, Nashville, TN 37208. Fax: 615-327-6417. Vol. 16, No. 1,1999 The tissue ridge that separates the LAA from PV is seen mainly on transesophageal echocardiography (TEE). When there is fat in this ridge, the well known appearance of a pseudomass is seen on TEE. This pseudomass is rarely seen on TTE. Similarly, the LAA has previously been poorly visualized on TTE. The improving quality of TTE imaging with newer echo systems allows LA pseudomasses previously demonstrated mainly on TEE to be visualized on TTE. References 1. Seward J: Critical appraisal of transesophageal echo cardiographs: limitations and pitfalls. In: Freeman W, Seward J, Khand heria B, et a1 (eds): Transesophageal Echocardiography. Boston, Little, Brown and Co., 1994. 2. Herzog CA, Bass D, Kane M, et al: Two dimensional echocardiographic imaging of left atrial appendage thrombi. J Am Coll Cardiol 1984;3: 1340 -1344. zyxw zyxwv ECHOCARDIOGRAPW: A Jrnl. of CV Ultrasound & Allied Tech. 31 zyxwvuts ADDAI AND POTTS zyxwvutsrq zyxwvu zyxwv zyx Figure 1. Arrow indicates the pseudomass. LA atrium; RV = right ventrucle. = zyxwvut zyxwv Figure 2. Arrow indicates the pseudomass. LAA vein; RA = right atrium; RV = right ventricle. 32 left atrium; LV = left ventricle; RA = right = left atrial appendage; PV ECHOCARDIOGWHY: A Jrnl. of CV Ultrasound & Allied Tech. = pulmonary Vol. 16, No. 1, 1999 zyxwvuts ATRIAL PSEUDOMASS zyxwvutsrq zyxwvu zyxwv Figure 3. Arrow indicates the pseudomass. A 0 PV = pulmonary vein. = aorta; LA = left atrium; LV = left ventricle; zyxwvuts zyx zyxwvutsrqp Figure 4. Arrow indicates the pseudomass. A 0 PV = pulmonary vein. Vol. 16,No. 1, 1999 = aorta; LA = lefr atrium; LV = left ventricle; ECHOCARDIOGWHY: A Jml. of CV Ultrasound & Allied Tech. 33