DK2985_C000 1..28 - AlSharqia Echo Club

500 Transesophageal Echocardiography(A)(B)LATSRAAoPAFigure 23.3 Fatty tissue in the transverse sinus (TS) (Ao, aorta; LA, left atrium; PA, pulmonary artery; RA, right atrium).[With permission of Oh et al. (5).]of its accessory lobes (Fig. 23.5). Rarely, partial absence ofthe pericardium gives rise to an abnormally large LAAwhich cannot be completely visualized.3. Intraventricular Bands and ChordsThe moderator band is a structure located at the apicalthird of the right ventricle (RV), extending from thelateral free wall to the septum. This prominent musculartrabeculation or ridge found only in the RV, is best visualizedin the mid-esophageal four-chamber view. Multiplemuscle bundles along the endocardial surface of the RVare also frequently present, giving it its typical trabeculatedappearance. When hypertrophied, these ventriculartrabeculae can become so prominent in the RV that theymay be confused with pathological masses (Fig. 23.6).False tendons or aberrant bands or chords are fibrousstructures crossing the left ventricular cavity with orwithout coexisting heart disease. Unlike true chordae tendinaewhich originate from papillary muscles, theseectopic chordae appear as linear echo-dense structuresextending either from free wall to free wall or from freewall to the ventricular septum. They are anatomic variantsof no clinical significance (Fig. 23.7).C. Lipomatous Infiltration of the HeartAccumulation of fibro-fatty tissue can occur in severallocations within the heart. The diagnosis of lipomatoushypertrophy of the atrial septum is made when its wallthickness is .15 mm. The thickened atrial septumshows a rather homogenous and bright echogenicity.Because the fibro-fatty infiltration spares the fossaovalis, the atrial septum has the typical appearance of adumb-bell (Fig. 23.8). This is a benign finding requiringno specific treatment. However, infiltration of the atrialseptum by tumors or Hodgkin’s lymphoma has also beendescribed. The concomitant presence of a pericardialeffusion, abnormal thickening of the walls of the Ao, thepulmonary veins or other adjacent structures as well asan inhomogeneous echotexture or a suspicion of a coinlesion within the septum makes the diagnosis of benignlipomatous infiltration less likely (6).(A)(B)LUPV«Q-TIP» SIGNLATHROMBUSIN LAALVFigure 23.4 Mid-esophageal 668 view of the left ventricle (LV) showing the “Q-tip” sign or appearance of the junction of the left atrialappendage (LAA) and left upper pulmonary vein (LUPV). Note also the thrombus in the LAA (LA, left atrium).