title: How to misuse echo contrast.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Dept of Clinical Physiology and Nuclear Medicine, University Hospital MAS, Lund University, Malmö, Sweden. magnus.dencker@skane.se
authors.forename: Magnus
authors.initials: M
authors.lastname: Dencker
authors.forename: Anna
authors.initials: A
authors.lastname: Missios
mesh_terms: D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D004417:Dyspnea / Q000000981:diagnostic imaging; D004452:Echocardiography; D005260:Female; D005773:Gastroscopy; D006338:Heart Neoplasms / Q000000981:diagnostic imaging*; D006551:Hernia, Hiatal / Q000000981:diagnostic imaging*; D006801:Humans