Prominent crista terminalis mimicking a right atrial mass: case report

Abstract

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.

Figure 1

Synoptic representation of prominent crista terminalis. Panel A: TTE, 4-chamber view; Panel B: TEE, short-axis view at the level of the aortic valve; Panel C: TEE, bicaval view; Panel D: TEE, bicaval view, posterior side; Panel E: MRI, axial view; Panel F: MRI, cranio-caudal view. Detailed explanation in the text. Abbreviations: CT = crista terminalis; IVC = inferior vena cava; LA = left atrium; LV = left ventricle; RA = right atrium; RAA = right atrial appendage; RV = right ventricle; SVC = superior vena cava.