The online version of this article (doi:10.1186/1476-7120-7-4) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
MD performed the echocardiography. AM was the treating physician. Both authors contributed to the manuscript and approved the final version.
Primary intracardiac tumours are rare, there are however several entities that can mimic tumours. Contrast echocardiography has been suggested to aid the differentiation of various suspected masses. We present a case where transthoracic echocardiography completely misdiagnosed a left atrial mass, partly due to use of echo contrast.
An 80 year-old woman was referred for transthoracic echocardiography because of one-month duration of worsening of dyspnoea. Transthoracic echocardiography displayed a large echodense mass in the left atrium. Intravenous injection of contrast (SonoVue, Bracco Inc., It) indicated contrast-enhancement of the structure, suggesting tumour. Transesophageal echocardiography revealed, however, a completely normal finding in the left atrium. Subsequent gastroscopy examination showed a hiatal hernia.
It is noteworthy that the transthoracic echocardiographic exam completely misdiagnosed what seemed like a left atrial mass, which in part was an effect of the use of echo contrast. This example highlights that liberal use of transoesophageal echocardiography is often warranted if optimal display of cardiac structures is desired.
Additional file 1: Movie of transthoracic echocardiography from parasternal long-axis view. The movie shows the rather large hiatal hernia. (AVI 5 MB)
Additional file 2: Movie of transthoracic echocardiography from apical four-chamber view. The movie shows the rather large hiatal hernia. (AVI 6 MB)
Additional file 3: Movie of transthoracic echocardiography from apical four-chamber view after injection of echo contrast. Note what appears to be irregular contrast uptake within the structure in the left atrium. (AVI 4 MB)
Cecconi M, Baldinelli A, Manfrin M, Fornari C, Sparvieri F: The false image of a left atrial mass due to a hiatal hernia: a case report. Ital Cardiol. 1994, 24: 527-531.
Airoldi L, Rizzotti M, Sarasso G, Francalacci G, Piccinino C, Occhetta E, Perucca A, Trevi G: False left atrial mass caused by hiatal hernia: a clinical case and review of the literature. Cardiologia. 1998, 43: 635-638. PubMed
Bandorski D, Hönscher R, Ibing R, Rieker W: A 77-year-old patient with suspected left atrial tumor. Internist (Berl). 2004, 45: 1047-1052. 10.1007/s00108-004-1251-2. CrossRef
Ker J, Van Beljon J: Diaphragmatic hernia mimicking an atrial mass: a two-dimensional echocardiographic pitfall and a cause of postprandial syncope. Cardiovasc J S Afr. 2004, 15: 182-183. PubMed
Smelley M, Lang RM: Large mass impinging on the left atrium: diagnostic value of a new cocktail. J Am Soc Echocardiogr. 2007, 20: 1414.e5-7. 10.1016/j.echo.2007.05.010. CrossRef
Main ML, Ryan AC, Davis TE, Albano MP, Kusnetzky LL, Hibberd M: Acute mortality in hospitalized patients undergoing echocardiography with and without an ultrasound contrast agent (multicenter registry results in 4,300,966 consecutive patients). Am J Cardiol. 2008, 102: 1742-1746. 10.1016/j.amjcard.2008.08.019. CrossRefPubMed
Dolan MS, Gala SS, Dodla S, Abdelmoneim SS, Xie F, Cloutier D, Bierig M, Mulvagh SL, Porter TR, Labovitz AJ: Safety and efficacy of commercially available ultrasound contrast agents for rest and stress echocardiography a multicenter experience. J Am Coll Cardiol. 2009, 53: 32-38. 10.1016/j.jacc.2008.08.066. CrossRefPubMed
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