Trans thoracic c ardiac windows • and standard 2d sections

It is challenging to differentiate a papillary fibroelastoma from giant Lambl's excrescence, as they are similar both echocardiographically and pathologically.
NORMAL ANATOMIC VARIANTS IN THE RIGHT VENTRICLE

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  Heavy trabeculation
  
• 
  Moderator band
  
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  Papillary muscles
  
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  Swan-Ganz catheter or pacer wire
  

Heavy trabeculation

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  Multiple trabeculation is a characteristic of RV.
  
• 
  pattern of trabeculation is highly variable and exaggeration of normal trabeculation might be confused for cardiomyopathy.
  

True pathologic hyper trabeculation occurring in developmental arrest of RV myocardium is rare, and it is often accompanied by other CHDs including tricuspid valve anomaly, ASD or VSD, & LVnon- compaction.

The moderator band


•The moderator band of the right ventricle has been misinterpreted as an intracardiac mass. This specialized cardiac trabeculation runs from the right ventricular free wall to the interventricular septum. It is often best seen in the ME four-chamber view.
Periaortic Echo-Free Space: Pericardial Sinus vs. Peri annular Abscess
■ Free pericardial fluid distributed within the transverse sinus and several recesses might be confused for a periannular abscess in transthoracic and TEE.
■ Diagnosis is particularly complicated in the febrile patients of post-operative course because the tissue edema and fluid collection due to inflammatory or procedural causes mimic the true pathologic process.

Periaortic echo-free space. A: Transverse pericardial sinus (asterisk) is normally seen at short axis view. B: Peri annular abscess (asterisk) due to infective endocarditis in a patient with a prosthetic aortic valve. Ao: ascending aorta, AVR: aortic valve replacement, LA: left atrium.