Echocardiographic evaluation of extracardiac masses

Echocardiography was performed on 5 patients with extracardiac masses. Four patients had solid tumours and the fifth had a cystic intrapericardial haematoma. Case 1 showed dense echoes anterior to the aortic root and over the right ventricle. Thoracotomy disclosed malignant infiltration ofthe anterior heart wall. The echocardiogram of case 2 showed a dense mass behind the anterior mitral leaflet, left ventricle, and the left atrium. Bronchoscopy disclosed a carcinoma of the left bronchus. An x-ray film of case 3 was suggestive of a pericardial effusion; no echoes were recordable from the left sternal border, and echocardiography from the right sternal border showed no evidence ofpericardial effusion. Necropsy showed a sarcoma which displaced the heart to the right. The ultrasound recording on case 4 in the supine position showed a dilated right ventricle and right ventricular outflow tract, and no evidence of pericardial effusion. In the left lateral position a large space in front of the right ventricle and a paradoxical decrease in right ventricular size were noted. Surgery showed an intrapericardial cystic haematoma anterior to the right ventricle. Echocardiography on case 5 showed a pericardial effusion and thickening (1.5 cm) of the anterior wall of the right ventricle. At operation a lymphoma infiltrating anterior wall of the right ventricle and a pericardial effusion were found. Careful gain control, examination of the patient in different positions, and placement of the transducer at the right sternal border in addition to the standard position helped in the delineation of these masses. Echocardiography may prove to be a useful method of diagnosing extracardiac space-occupying lesions.