Coumadin Ridge
A prominent muscle ridge is formed between the LAA and the atrial insertion of the LUPV is referred to as the coumadin ridge or "Q-tip" sign.
This prominence is often misdiagnosed as thrombus.
lack of mobility and characteristic location, best seen in the ME two-chamber view, help distinguish it from an abnormal structure.
NORMAL ANATOMIC VARIANTS IN LEFT VENTRICLE
■ False tendon
■ Papillary muscles
Left ventricular web (aberrant chordae)
■ Prominent mitral annular calcification
. false tendons are fibromuscular structures crossing the LV cavity.
. LV bands may pass between papillary muscles, from papillary muscle to the ventricular septum, between free walls, or from free wall to interventricular septum, in contrary to true chordae tendineae connecting papillary muscle and mitral valve leaflets.
■ False tendon is found up to 55% in normal hearts by autopsy.
In echo, LV bands appear as string-like thin bands passing LV cavity, which may be transverse, longitudinal, or sagittal, and single or multiple.
■ location, direction, length and thickness of LV bands may vary depending on their embryonic origin of inner cardiac muscle layer and contents
Papillary muscle variants
■ Papillary muscle variants in architecture and location have peculiar clinical significance in hypertrophic cardiomyopathy.
Anterior displacement of hypertrophied papillary muscle is known to accentuate the resting trans-LV outflow tract pressure gradients.
Papillary muscles
■ vary in shape, thickness, & location in LV wall.
■ More than one belly is observed in up to 50%.
■ Accessory papillary muscle may be confused for pathologic structures such as LV thrombus or papillary muscle tumors when it arises from an unusual location.
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