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