Echo-of-the-Day

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AMA Category 1 Credit for Physicians Only.
ASRT CME is not available.

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).

You can change the size and the format of the image or video loops by using the links below the image or video loop.

= Windows Media Video	= MP4 Video
= QuickTime	= WebM Video
= Flash	= Ogg Video
= JPG Image	= GIF Image
Image/Video Sizes
1X = 200x150 pixels 2X = 400x300 pixels	3X = 600x450 pixels 4X = 800x600 pixels

Loop Text Key
Preop	Preop TEE or TTE
Intraop	An Intraop TEE
IntraopPreOp	Intraop TEE or TTE before Operation
IntraopPostOp	Intraop TEE or TTE after Operation
IntraopEnd	Intraop TEE or TTE at End of Anesthesia
Post Op	Postop TEE or TTE
	= Legacy/Old Video Formats

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.

Presentation:
82 yo male with history of systolic murmur, CHF, SOB, and chest pain. He presents to the operating room with the following echo loops:

Loop(s):

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:

Myxoma
Thrombus
Fibroelastoma

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.

CME Section

Please answer the following questions correctly to obtain your CME.

Web Links/References

Papillary fibroelastoma. A right atrial presentation.
Right atrial papillary fibroelastoma.
Right atrial mass: Thrombus
myxoma
or cardiac papillary fibroelastoma?
Clinical and Echocardiographic Characteristics of Papillary Fibroelastomas

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This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of University of Nebraska Medical Center, Center for Continuing Education and JLS Interactive, LLC.

The University of Nebraska Medical Center, Center for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

This activity is approved by the American Society of Radiologic Technologists (ASRT) as sonography-related continuing education (CE). Credit(s) issued for successful completion of ASRT-approved CE activities are accepted by the American Registry of Diagnostic Medical Sonography, American Registry of Radiological Technologists, Cardiovascular Credentialing International and Canadian Association of Registered Diagnostic Ultrasound Professionals. Contact the applicable registry for additional information / restrictions on their acceptance of ASRT CE credit.