Echocardiographic evaluation of extracardiac masses.

Echocardiography was performed on 5 patients with extracardiac masses. Four patients had solid tumours and the fifth had a cystic intrapericardial haematoma. Case 1 showed dense echoes anterior to the aortic root and over the right ventricle. Thoracotomy disclosed malignant infiltration ofthe anterior heart wall. The echocardiogram of case 2 showed a dense mass behind the anterior mitral leaflet, left ventricle, and the left atrium. Bronchoscopy disclosed a carcinoma of the left bronchus. An x-ray film of case 3 was suggestive of a pericardial effusion; no echoes were recordable from the left sternal border, and echocardiography from the right sternal border showed no evidence ofpericardial effusion. Necropsy showed a sarcoma which displaced the heart to the right. The ultrasound recording on case 4 in the supine position showed a dilated right ventricle and right ventricular outflow tract, and no evidence of pericardial effusion. In the left lateral position a large space in front of the right ventricle and a paradoxical decrease in right ventricular size were noted. Surgery showed an intrapericardial cystic haematoma anterior to the right ventricle. Echocardiography on case 5 showed a pericardial effusion and thickening (1.5 cm) of the anterior wall of the right ventricle. At operation a lymphoma infiltrating anterior wall of the right ventricle and a pericardial effusion were found. Careful gain control, examination of the patient in different positions, and placement ofthe transducer