title: Transthoracic Echocardiography: Pitfalls and Limitations as Delineated at Cardiac CT and MR Imaging.
abstract: Transthoracic echocardiography ( TTE transthoracic echocardiography ) is a critical tool in the field of clinical cardiology. It often serves as one of the first-line imaging modalities in the evaluation of cardiac disease owing to its low cost, portability, widespread availability, lack of ionizing radiation, and ability to evaluate both anatomy and function of the heart. Consequently, a large majority of patients undergoing a cardiac computed tomography (CT) or magnetic resonance (MR) imaging examination will have a TTE transthoracic echocardiography available for review. Therefore, it is imperative that cardiac imagers be familiar with the fundamentals of a routine TTE transthoracic echocardiography examination and common TTE transthoracic echocardiography pitfalls and limitations that may lead to a referral for cardiac CT or MR imaging. The four standard TTE transthoracic echocardiography windows and their corresponding views will be discussed and the relevant anatomy highlighted. Common pitfalls and limitations of TTE transthoracic echocardiography will be highlighted using cardiac CT and MR imaging as the problem-solving modality. In this article, we have categorized the relevant pitfalls and limitations of TTE transthoracic echocardiography into four broad categories: (a) masses and mass mimics (crista terminalis, eustachian valve, right ventricle moderator band, atrioventricular groove fat, left ventricular band [or left ventricular false tendon], hiatal hernia, caseous calcification of the mitral annulus, lipomatous hypertrophy of the interatrial septum, cardiac tumors), (b) poorly visualized apical lesions (aneurysm, thrombus, infarct, and hypertrophic and other nonischemic cardiomyopathies), (c) evaluation for ascending thoracic aortic dissections (false positive, false negative, dissecting aneurysms), and (d) pericardial disease (acute and chronic/constrictive pericarditis, pericardial tamponade, pericardial cysts and diverticula, congenital absence of the pericardium). Online supplemental material is available for this article.©RSNA, 2017.
authors.affiliation: From the Department of Diagnostic Imaging, Kaiser Permanente Los Angeles Medical Center, 1505 N Edgemont Ave, Basement, Los Angeles, CA 90027.
authors.forename: Sachin B
authors.initials: SB
authors.lastname: Malik
authors.affiliation: From the Department of Diagnostic Imaging, Kaiser Permanente Los Angeles Medical Center, 1505 N Edgemont Ave, Basement, Los Angeles, CA 90027.
authors.forename: Natalie
authors.initials: N
authors.lastname: Chen
authors.affiliation: From the Department of Diagnostic Imaging, Kaiser Permanente Los Angeles Medical Center, 1505 N Edgemont Ave, Basement, Los Angeles, CA 90027.
authors.forename: Rex A
authors.initials: RA
authors.lastname: Parker
authors.affiliation: From the Department of Diagnostic Imaging, Kaiser Permanente Los Angeles Medical Center, 1505 N Edgemont Ave, Basement, Los Angeles, CA 90027.
authors.forename: Joe Y
authors.initials: JY
authors.lastname: Hsu
mesh_terms: D003937:Diagnosis, Differential; D004452:Echocardiography / Q000379:methods*; D006331:Heart Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D008279:Magnetic Resonance Imaging; D014057:Tomography, X-Ray Computed