Multimodal imaging using TTE, TEE, and CCTA successfully identified a 12x9 mm right atrial mass as crista terminalis hypertrophy in a 58-year-old female, preventing unnecessary interventions.
Case Report (n=1)
A multimodal imaging approach, including CCTA or CMR, is essential for accurately diagnosing crista terminalis hypertrophy and avoiding unnecessary invasive interventions or anticoagulation.
Background and Clinical Significance: The crista terminalis (CT) is a physiological fibromuscular ridge in the right atrium. While benign, rare cases of CT hypertrophy present a diagnostic challenge, as it can mimic a pathological right atrial mass on cardiac imaging. The CT also presents arrhythmogenic potential and is known to be associated with right atrial tachyarrhythmias. Case Presentation: We present the case of a 58-year-old female that presented with rapid, irregular palpitations, accompanied by hypertension. Holter electrocardiography (ECG) confirmed self-limiting episodes of atrial tachycardia (max heart rate 170 bpm). Initial transthoracic echocardiography (TTE) identified an echogenic, non-mobile mass on the posterolateral right atrial wall. Transesophageal echocardiography (TEE) confirmed a 12 × 9 mm homogenous structure with a broad base of implantation and no intrinsic mobility, initially raising the suspicion of an atrial lipoma. Subsequent cardiac computed tomography angiography (CCTA) provided high-resolution tissue characterization, identifying the mass as a hypertrophied CT due to its precise anatomical orientation and its lack of contrast enhancement, also ruling out neoplastic and thrombotic aetiologies. Conclusions: CT hypertrophy is a key differential diagnosis for right atrial masses, particularly in females in their sixth decade. A multimodal imaging approach, transitioning from TTE to TEE and finally CCTA or Cardiac Magnetic Resonance Imaging (CMR), is advantageous in preventing unnecessary invasive interventions or anticoagulation.
Racz et al. (2026) conducted a case report in Crista terminalis hypertrophy (n=1). Multimodal imaging (TTE, TEE, CCTA) was evaluated. Multimodal imaging using TTE, TEE, and CCTA successfully identified a 12x9 mm right atrial mass as crista terminalis hypertrophy in a 58-year-old female, preventing unnecessary interventions.