EchoBridgeMD Pearl #2: Distinguishing Right Heart Thrombus, Vegetation, and Cardiac Tumor

Not every intracardiac mass has the same appearance on echocardiography.

A right heart thrombus (RHT) typically appears as a long, thin, highly mobile, free-floating "worm-like" mass that may prolapse through the tricuspid or pulmonic valve during the cardiac cycle.

In contrast, vegetations are irregular, oscillating masses attached to the valve or to prosthetic material. Cardiac tumors generally demonstrate a broad-based attachment to the chamber wall or valve and may be associated with local invasion, pericardial effusion, or internal vascularity on color Doppler.

Recognizing these distinguishing features can rapidly narrow the differential diagnosis and guide urgent management.

Reference:

📖 Alerhand S, Adrian RJ. What echocardiographic findings differentiate acute pulmonary embolism and chronic pulmonary hypertension? Am J Emerg Med. 2023.

https://pubmed.ncbi.nlm.nih.gov/37499553/

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