The Role of 3DE in the Evaluation of Cardiac Masses

Echocardiography is the most frequently used imaging modality to assess intra-cardiac masses. Twodimensional 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. Threedimensional 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.