Masses/Thrombus/Endocarditis

Question 1

What are the 3 RA structures that can mimic masses?

Answer 1

1. Crista terminalis
2. Eustachian valve
3. Chiari network

Question 2

Are benign or malignant primary tumours more common?

Answer 2

Benign

Question 3

Benign tumour that is attached by a stalk to the IAS

Answer 3

Myxoma

Question 4

LA/IAS, mobile, plop sound, large

Answer 4

Myxoma

Question 5

Most common primary benign tumour found in adults

Answer 5

Myxoma

Question 6

Benign primary tumour that is small and often attached to valves

Answer 6

Papillary fibroelastoma

Question 7

Primary benign tumour made of fatty tissue

Answer 7

Lipoma

Question 8

Most common valvular heart tumour

Answer 8

Papillary fibroelastoma (PFE)

Question 9

Where are PFE’s usually found on the AV and MV/TV?

Answer 9

AV: aortic side, MV/TV: atrial side

Question 10

Echogenic, encapsulated tumour

Answer 10

Lipoma

Question 11

Lipoma vs. Lipomatous hypertrophy of the IAS

Answer 11

Lipomatous hypertrophy has a dumbbell appearance where it is not found over the foramen ovale

Question 12

Most common primary malignant tumour

Answer 12

Angiosarcoma

Question 13

Primary malignancy that is made of striated muscle and usually found in younger patients

Answer 13

Rhabdomyosarcoma

Question 14

Which is more common, primaries or mets?

Answer 14

Mets are way more common

Question 15

Thickened/retracted TV leaflets and massive TR can be a sign of what?

Answer 15

Carcinoid heart disease

Question 16

What is Virchow’s triad for thrombus?

Answer 16

1. Endothelial injury (abnormal walls)
2. Abnormal flow (hemodynamic changes: stasis)
3. Hypercoagulability

Question 17

What is smoke?

Answer 17

A precursor to thrombus

Question 18

Is older thrombus more or less echogenic?

Answer 18

More echogenic

Question 19

Is protruding more acute or chronic? Is protruding or mural more at risk for embolus?

Answer 19

Acute and protruding more likely to embolise

Question 20

Why is TEE the #1 choice for assessing LA thrombi?

Answer 20

The LAA is seen and the LA is closest to the probe

Question 21

Name 3 predispositing factors for thrombus

Answer 21

Stagnant flow, aneurysms, shunts, a-fib, rheumatic disease, congenital HD, prosthetic valves

Question 22

A microbial infection that enters the heart and may cause tissue destruction or abscess formation

Answer 22

Endocarditis

Question 23

Most common cause of acute endocarditis

Answer 23

Staph infection

Question 24

CHF, flu-like symptoms, chest pain, fever, +blood cultures

Answer 24

S/S of infective endocarditis

Question 25

What is the clinical triad for IE?

Answer 25

1. • blood cultures
2. Fever
3. New murmur

Question 26

What are the features of a vegetation?

Answer 26

Upstream a valve, mobile, irregular

Question 27

T/F a bi/unicuspid AV is most likely to get involved with endocarditis

Answer 27

True

Question 28

What is the most common veg location? Which side is it usually on?

Answer 28

MV on atrial side

Question 29

Which side is an AV vegetation usually found?

Answer 29

LV side