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Echo-of-the-Day Information
The Case-of-the-Week is a presentation of 8 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
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
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Case of the Month Information Table
IntraopEnd is usually a TEE after the Operation and after some event occured to show a change in the TEE
Mass in the RVOT
Case#: 261
AMA CME Units: 0 Units
This EOTD didn't qualify for CME credits. .
A patient presented with the following echo loops:
Case Discussion
This is not a mass in the right ventricle, RVOT or the pulmonary valve. The image is a false structure. Since it is a linear artifact one would be tempted to call this a side lobe artifact from the pulmonary valve and/or annulus but the artifact is really a mirror artifact that is mirroring the aortic valve annulus. The mirrored segment of the aortic valve annulus is from the middle of the left coronary cusp to the interatrial septum. The key finding was that when the middle segment of the left coronary cusp aortic valve annulus increases in size, so does the artifact. The pulmonary valve origin of the artifact does not increase in size. Also, the artifact is not really linear, it is more dumbbell shaped. Mirror artifacts simulate another structure in the sector scan and appear more distal to the TEE probe. Mirror artifacts are also equidistant from the mirrored source. If mirror artifacts appear closer to the TEE probe than the structure being mirrored, it is then due to a timing artifact, where the probe receives the mirrored signal on the next scan sweep so the machine displays the artifact closer than the original structure. Mirror artifacts can frequently be found to be artifacts by viewing the same structure from a different angle and noting that the artifact is no longer present. Side lobe artifacts can appear as an arc in the sector scan and are due to the presence of a high specular reflector in the sector scan, such as a catheter, wire, or a calcium deposit.
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