The Role of 3DE in the Evaluation of Cardiac Masses

  • Francesco Fulvio FaletraEmail author
  • Romina Murzilli
  • Laura Anna Leo
  • Denisa Muraru


Echocardiography is the most frequently used imaging modality to assess intra-cardiac masses. Two-dimensional echocardiography uses orthogonal tomographic planes obtained from several acoustic windows to try to mentally reconstruct a model of how the mass would actually appear in three dimensions and how it would relate to the adjacent cardiac structures. Three-dimensional transthoracic and transesophageal echocardiography have revolutionized the echocardiographic assessment of intracardiac masses. A single acquisition of a three-dimensional data set can be post-processed to show the actual size and shape of the mass and characterize its volume, location, point of attachment, relationships with adjacent structures empowering the echocardiographer with a new level of confidence in the diagnosis, follow-up and management of patients with intracardiac masses.

In the first part of the chapter, we will describe how the most frequent benign and malign tumors appear on 3DE imaging. The second part of the chapter will cover non-tumor masses, in particular thrombi and vegetations. The last part will describe some normal intracardiac structures that may protrude in the heart cavities and appear as cardiac masses when exuberant.


Intracardiac masses Primary cardiac tumors Secondary cardiac tumors Myxoma Lamb’s excrescences Non-tumor masses 

Supplementary material

Video 24.1a

Volume rendering of left atrial myxoma (AVI 4787 kb)

Video 24.1b

Color volume rendering of left atrial myxoma (AVI 1555 kb)

Video 24.1c

Biplane display of left atrial myxoma (AVI 27355 kb)

Video 24.2a

Conventional 4-chamber two-dimensional view of left atrial myxoma occluding the mitral orifice in diastole and falling deep in the left ventricle (AVI 26256 kb)

Video 24.2b

Transthoracic 3DE and volume rendering of left atrial mixomaCardiac massesprimary cardiac tumorsmixoma visualized in longitudinal cut plane to show the point of attachment to interatrial septum and its prolapse into the left ventricle through the mitral orifice (AVI 10453 kb)

Video 24.2c

Transthoracic 3DE and volume rendering of left atrial mixomaCardiac massesprimary cardiac tumorsmixoma visualized from left ventricular perspective, using a transversal cut plane, to examine its protrusion through the mitral annulus (AVI 15478 kb)

Video 24.2d

Transthoracic 3DE and volume rendering of left atrial mixoma visualized from the atrial perspective using a transversal cut plane to show the large stalk and the point of attachment to interatrial septum (AVI 14181 kb)

Video 24.3

Two-dimensional echocardiography of left atrial myxoma with irregular shape. Although the diagnosis of myxoma is unquestionable, the precise size and shape of the tumor is difficult to define since during the cardiac cycle parts of the tumor appear and disappear as it moves through the echocardiographic plane. Ao aorta, LA left atrium, LV left ventricle (AVI 1873 kb)

Video 24.4

Transesophageal 3DE image showing volume renderingDisplayvolume rendering display of the same case of Video 24.3. The tumor seen from above to show the margins of the tumor attached on the atrial wall and its spatial relationships with the mitral valve (AVI 3231 kb)

Video 24.5

Transesophageal 3DE volume rendering of a myxomas with multiple excrescencies (AVI 2186 kb)

Video 24.6a

Classic transthoracic two-dimensional transesophageal echocardiography appearance of papillary fibroelastoma attached on the endocardium of the aortic root (AVI 31600 kb)

Video 24.6b

Transesophageal 3DE volume rendering of papillary fibroelastoma attached on the endocardium of the aortic root providing a better assessment of its shape, position (near the sino-tubular junction on the commissure between the non-coronary and left coronary leaflets (AVI 15218 kb)

Video 24.6c

Transesophageal 3DE volume rendering of papillary fibroelastoma attached on the endocardium of the aortic root showing the thin attachment of the mass to the aortic root (AVI 19391 kb)

Video 24.7a

Transthoracic 3DE data set obtained from a subcostal approach with a longitudinal cut of the inferior vena cava to show a renal cell carcinoma emerging from the inferior vena cava (AVI 3167 kb)

Video 24.7b

Transthoracic 3DE data set obtained from a subcostal approach with a transversal cut of the inferior vena cava to show a renal cell carcinoma emerging from the inferior vena cava. IVC inferior vena cava, LA left atrium, LV left ventricle, RA right atrium, RV right ventricle (AVI 4544 kb)

Video 24.8

Transthoracic 3DE in a patient with left ventricular thrombi (AVI 5606 kb)

Video 24.9

Transesophageal 3DE volume rendering of a huge thrombus originating form superior vena cava, which appears obstructed, and protruding into the right atrium. CT crista terminalis, RAA right atrial appendage, SVC superior vena cava, Th thrombus (AVI 1987 kb)

Video 24.10

Transesophageal 3DE volume rendering of a large endocarditis vegetation attached at the ventricular surface of the left coronary aortic leaflet (AVI 2179 kb)

Video 24.11a

Two-dimensional transthoracic 4-chamber view showing a crista terminalis that may easily misdiagnosed for a tumor or thrombus attached to the superior wall of right atrium (AVI 14971 kb)

Video 24.11b

Transthoracic 3DE showing a terminal crest extending from the superior vena cava (not seen in the image) towards the tricuspid orifice. IAS interatrial septum, LA left atrium, LV left ventricle, RV right ventricle, SVC superior vena cava, TC terminal crest (AVI 5179 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Francesco Fulvio Faletra
    • 1
    Email author
  • Romina Murzilli
    • 1
  • Laura Anna Leo
    • 1
  • Denisa Muraru
    • 2
  1. 1.Department of CardiologyFondazione Cardiocentro TicinoLuganoSwitzerland
  2. 2.University of Milano-Bicocca, and Istituto Auxologico Italiano, IRCCS, San Luca HospitalMilanoItaly

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