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Echo-of-the-Day Information
The Echo-of-the-Day is a presentation of 1 or more video loops to present an important topic in echocardiography. Please reveiw the image or video loops and then answer the questions below. After you have answered the questions you can view the explanation and obtain CME credit (if available).

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Preop Preop TEE or TTE
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Echo of the Day Information Table
IntraopEnd is usually a TEE after the Operation and after some event occured to show a change in the TEE
Just a routine case.
Case#: 325
AMA CME Units: 0.25 Units
Estimated Time: 15 minutes.
82 yo male with history of systolic murmur, CHF, SOB, and chest pain. He presents to the operating room with the following echo loops:
Case Discussion
The primary diagnosis is severe aortic stenosis.

The secondary finding is a right atrial mass. The mass is attached to the right atrial wall and could be near the coronary sinus or the atrial septum. The differential diagnosis is:


The tumor, in this case was a papillary fibroelastoma. Right atrial fibroelastomas are rare. There are only a few published reports of papillary fibroelastoma's arising from the right atrium. Fibroelastomas tend to embolize. Therefore, right atrial fibroelastomas could remain relatively silent (compared to left sided fibroelastomas that can produce TIAs or CVAs) and tend to be larger and may cause obstructive symptoms. Fibroelastomas can arise from anywhere there is endocardium. Usually, fibroelastomas are found on valves (84%) and on the left side of the heart. Fibroelastomas, when found on a valve, are usually on the upstream side of the valve. Fibroelastomas are usually small (< 2 cm), when discovered, but can become quite large and can be attached by a stalk. Fibroelastomas have many frond like (like a sea anemone) projections that can embolize. Fibroelastomas have even been found in the Chiari network. Fibroelastomas usually occur singly, but can be multiple. Fibroelastomas can occur with or without a stalk. When they occur with a stalk they are mobile. When they occur without a stalk, they are immobile.

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