A 59-year-old man presented with fever and cough. An examination revealed jugular venous distention, pulsus paradoxus of 15 mmHg, bibasilar pulmonary rales and diminished heart sounds. A chest x-ray showed cardiomegaly and a right lower lobe infiltrate. Two-dimensional transthoracic echocardiography (Figure 1) demonstrated a large pericardial effusion (EFF) with signs of cardiac tamponade. Multiple intrapericardial strands (arrowheads) were seen within the pericardial fluid. Three-dimensional transthoracic echocardiography (Figure 2) provided additional information regarding the size, thickness and extent of the strands. Three-dimensional imaging revealed the strands to be an extensive network of intrapericardial adhesions (arrowheads) extending from the visceral pericardium to the thickened parietal pericardium (PER). Right heart catheterization was performed and demonstrated a right atrial pressure of 19/14 mmHg, right ventricular pressure of 36/16 mmHg and mean pulmonary capillary wedge pressure of 15 mmHg. Following echocardiographic-guided removal of 1700 mL of exudative fluid, right atrial pressure fell to 8/2 mmHg. Pericardial fluid stains and cultures were negative. The patient improved after the institution of antibiotics for pneumonia. Figure 1 Figure 2

Shadwan Alsafwah, M.D., Daniel Minderman, R.D.C.S.,∗ Maram Mallisho, M.D.,∗ Ahmad Munir, M.D.∗ Division of Cardiovascular Diseases, Department of Internal Medicine, University of Tennessee Health Science Center; ∗VA Medical Center, Memphis, Tennessee, USA Address for correspondence: Shadwan Alsafwah, M.D. Division of Cardiovascular Diseases University of Tennessee Health Science Center 920 Madison Ave., Suite 300 Memphis, TN 38 163, USA salsafwah@msn.com

A 57-year-old man presented with acute coronary syndrome for which he was initially treated medically with a regimen that included acetylsalicylic acid, clopidogrel and heparin. Later, he was found to have two-vessel coronary artery disease requiring coronary artery bypass grafting. His postoperative period was complicated by hypotension and excessive bleeding, requiring multiple transfusions of blood products. His continued hemodynamic instability led to the suspicion of a mechanical complication. A transthoracic left parasternal short-axis view at the mitral valve level showed an anterior mediastinal hematoma compressing the right ventricular outflow tract (Figure 1). Figure 1) Transthoracic left parasternal short-axis view showing an anterior mediastinal hematoma (MH) compressing the right ventricular outflow tract. LV Left ventricle; RV Right ventricle The hematoma was also compressing the main pulmonary artery with its bifurcation, as well as the aorta, as shown by the transthoracic high right parasternal short-axis view (Figure 2). Figure 2) Transthoracic high right parasternal short-axis view showing the mediastinal hematoma (MH) compressing the aorta (Ao), as well as the main pulmonary artery with its bifurcation. LMPA Left main pulmonary artery The patient was taken back to the operating room, where the hematoma was evacuated. He did very well after that and left the hospital five days later (1).

A 60-year-old woman was admitted with pulmonary edema and a holosystolic apical murmur. She had had Raynaud’s disease for two years and scleroderma for 20 years. On two-dimensional echocardiography, the mitral valve appeared mildly thickened, the papillary muscle was much thickened, and the chordae tendineae were sclerotic and much shortened (Figure 1A). Colour Doppler imagery showed severe mitral regurgitation (Figure 1B). Three-dimensional echocardiography confirmed very thick papillary muscles and almost direct insertion of papillary muscles on the mitral leaflets due to severe chordal shortening, which prevented proper apposition of the mitral leaflets (Figures 1C, 1D and 1E). A virtual section of the papillary muscles on three-dimensional imaging electronically showed patches of echogenic tissue (presumably fibrosis) within the ventricular myocardium, a hallmark of systemic sclerosis (1). Figure 1 A Two-dimensional echocardiography, parasternal long-axis view, showing the papillary muscle (PM) inserted apparently directly on the anterior leaflet of the mitral valve (MV) due to very shortened chordae tendineae (CT). B Two-dimensional echocardiography, ...

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Respiratory variations in the caliber of the inferior vena cava, imaged in the subcostal view with the patient supine, correlated well with respiratory variation in the caliber of the right subclavian vein with the patient reclining at a 45 degrees angle. The subclavian vein was imaged by a right supraclavicular approach. We suggest that the right subclavian vein caliber be used as a surrogate of the inferior vena cava caliber when the latter cannot be used because of obesity, epigastric tenderness, or other reasons.

EchocardiographyVolume 24, Issue 3 p. 279-283 Use of Contrast in Distinguishing Apical Mural Thrombus from Its Echocardiographic Simulators Rami N. Khouzam M.D., Rami N. Khouzam M.D. University of Tennessee Health Science Center and Memphis VA Medical Center, Memphis, TennesseeSearch for more papers by this authorIvan A. D'Cruz M.D., F.R.C.P., Ivan A. D'Cruz M.D., F.R.C.P. University of Tennessee Health Science Center and Memphis VA Medical Center, Memphis, TennesseeSearch for more papers by this authorDaniel Minderman R.D.C.S., Daniel Minderman R.D.C.S. University of Tennessee Health Science Center and Memphis VA Medical Center, Memphis, TennesseeSearch for more papers by this author Rami N. Khouzam M.D., Rami N. Khouzam M.D. University of Tennessee Health Science Center and Memphis VA Medical Center, Memphis, TennesseeSearch for more papers by this authorIvan A. D'Cruz M.D., F.R.C.P., Ivan A. D'Cruz M.D., F.R.C.P. University of Tennessee Health Science Center and Memphis VA Medical Center, Memphis, TennesseeSearch for more papers by this authorDaniel Minderman R.D.C.S., Daniel Minderman R.D.C.S. University of Tennessee Health Science Center and Memphis VA Medical Center, Memphis, TennesseeSearch for more papers by this author First published: 15 February 2007 https://doi.org/10.1111/j.1540-8175.2007.00390.xCitations: 1 Address for correspondence and reprint requests: Ivan A. D'Cruz, M.D., Cardiology Section, VA Medical Center, 1030 Jefferson Ave, Memphis, TN 38104. Fax: (901)-577-7430; E-mail: [email protected] Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat References 1 DeMaria AN, Bommer W, Neumann A, et al: Left ventricular thrombi identified by cross-sectional echocardiography. Ann Intern Med 1979; 90: 14–18. 2 Arvan S: Mural thrombi in coronary artery disease: Recent advances in pathogenesis, diagnosis, and approaches to treatment. Arch Intern Med 1984; 144: 113–116. 3 Stratton JR, Lighty GW Jr, Pearlman AS, et al: Detection of left ventricular thrombus by two-dimensional echocardiography: Sensitivity, specificity, and causes of uncertainty. Circulation 1982; 66: 156–166. 4 Asinger RW, Mikell FL, Sharma B, et al: Observations on detecting left ventricular thrombus with two dimensional echocardiography: Emphasis on avoidance of false positive diagnoses. Am J Cardiol 1981; 47: 145–156. 5 Crouse LJ, Cheirif J, Hanly DE, et al: Opacification and border delineation improvement in patients with sub-optimal endocardial border definition in routine echocardiography: Results of the Phase III Albunex Multicenter Trial. J Am Coll Cardiol 1993; 22: 1494–1500. 6 Kontny F, Dale J, Hegrenaes L, et al: Left ventricular thrombosis and arterial embolism after thrombolysis in acute anterior myocardial infarction: Predictors and effects of adjunctive antithrombotic therapy. Eur Heart J 1993; 14: 1489–1492. 7 Gottdiener JS, Gay JA, VanVoorhees L, et al: Frequency and embolic potential of left ventricular thrombus in dilated cardiomyopathy: assessment by 2-dimensional echocardiography. Am J Cardiol 1983; 52: 1281–1285. 8 Vaitkus PT, Barnathan ES: Embolic potential, prevention and management of mural thrombus complicating anterior myocardial infarction: A meta-analysis. J Am Coll Cardiol 1993; 22: 1004–1009. 9 Falk RH, Foster E, Coats MH: Ventricular thrombi and thromboembolism in dilated cardiomyopathy: A prospective follow-up study. Am Heart J 1992; 123: 136–142. 10 Sinha A, Nanda NC, Khanna D, et al: Morphological assessment of left ventricular thrombus by live three-dimensional transthoracic echocardiography. Echocardiography 2004; 21: 649–655. 11 Duncan K, Nanda NC, Foster WA, et al: Incremental value of live/real time three-dimensional transthoracic echocardiography in the assessment of left ventricular thrombi. Echocardiography 2006; 23: 68–72. 12 Keren A, Goldberg S, Gottlieb S, et al: Natural history of left ventricular thrombi: Their appearance and resolution in the posthospitalization period of acute myocardial infarction. J Am Coll Cardiol 1990; 15: 790–800. 13 Ezekowitz MD: Imaging techniques for identifying left ventricular thrombi. Am J Card Imaging 1994; 8: 81–88. 14 Thanigaraj S, Perez JE: Apical hypertrophic cardiomyopathy: Echocardiographic diagnosis with the use of intravenous contrast image enhancement. J Am Soc Echocardiogr 2000; 13: 146–149. 15 Thanigaraj S, Schechtman KB, Perez JE: Improved echocardiographic delineation of left ventricular thrombus with the use of intravenous second-generation contrast image enhancement. J Am Soc Echocardiogr 1999; 12: 1022–1026. 16 Pandian NG: Clinical applications of contrast echocardiography. Eur J Echocardiogr 2004; 5(Suppl. 2): 3–10. 17 Visser CA, Kan G, Meltzer RS, et al: Embolic potential of left ventricular thrombus after myocardial infarction: A two-dimensional echocardiographic study of 119 patients. J Am Coll Cardiol 1985; 5: 1276–1280. Citing Literature Volume24, Issue3March 2007Pages 279-283 ReferencesRelatedInformation

A patient with pericardial effusion and tamponade was studied by routine two‐dimensional as well as three‐dimensional echocardiogram. Chamber “collapses” of the right atrium, left atrium, right ventricle, and inferior vena cava were visualized by both modalities, but were better appreciated on three‐dimensional echo imaging, perhaps because three‐dimensional echo imaging is more suited to depicting three‐dimensional changes in chamber shape.

It was realized 20 years ago that the sonographic appearance of a diaphragmatic hernia could simulate a left atrial mass. Many papers have appeared on this topic since then, but they mainly consist of single case reports. Clinical symptoms due to cardiac compression by the hernia are uncommon but may occur if the hernia is very large; such patients have presented with episodes of syncope or dyspnea, typically after a large meal. Sonographers, cardiologists, gastroenterologists, and internists are generally not yet aware that sonographic presentations can be varied and are often perplexing. These include the combination of hiatal hernia with gastroesophageal reflux demonstrable in the subcostal view, and hiatal hernia in patients with ascites.

A 50‐year‐old patient with end‐stage renal disease who was being dialyzed with an internal jugular catheter presented with fever. Transthoracic and transesophageal echo demonstrated a thrombus in the inferior venacava, protruding into the right atrium and extending to the eustachian valve to which it was adherent. Multiple organisms grew from the blood as well as the catheter tip. Antibiotic therapy was started with Vancomycin and Gentamicin but later changed to other combinations according to sensitivity studies. Coumadin was also given.

EchocardiographyVolume 24, Issue 3 p. 276-278 Persistent Ductus Venosus in an Adult Associated with Hypertrophic Cardiomyopathy and Pulmonary Hypertension Rami N. Khouzam M.D., Rami N. Khouzam M.D. University of Tennessee Health Science Center and Memphis VA Medical Center, Memphis, TennesseeSearch for more papers by this authorK.B. Ramanathan M.D., K.B. Ramanathan M.D. University of Tennessee Health Science Center and Memphis VA Medical Center, Memphis, TennesseeSearch for more papers by this authorDaniel Minderman R.D.C.S., Daniel Minderman R.D.C.S. University of Tennessee Health Science Center and Memphis VA Medical Center, Memphis, TennesseeSearch for more papers by this authorIvan A. D'Cruz M.D., F.R.C.P., Ivan A. D'Cruz M.D., F.R.C.P. University of Tennessee Health Science Center and Memphis VA Medical Center, Memphis, TennesseeSearch for more papers by this author Rami N. Khouzam M.D., Rami N. Khouzam M.D. University of Tennessee Health Science Center and Memphis VA Medical Center, Memphis, TennesseeSearch for more papers by this authorK.B. Ramanathan M.D., K.B. Ramanathan M.D. University of Tennessee Health Science Center and Memphis VA Medical Center, Memphis, TennesseeSearch for more papers by this authorDaniel Minderman R.D.C.S., Daniel Minderman R.D.C.S. University of Tennessee Health Science Center and Memphis VA Medical Center, Memphis, TennesseeSearch for more papers by this authorIvan A. D'Cruz M.D., F.R.C.P., Ivan A. D'Cruz M.D., F.R.C.P. University of Tennessee Health Science Center and Memphis VA Medical Center, Memphis, TennesseeSearch for more papers by this author First published: 15 February 2007 https://doi.org/10.1111/j.1540-8175.2007.00389.x Address for correspondence and reprint requests: Ivan A. D'Cruz, M.D., Cardiology Section, VA Medical Center, 1030 Jefferson Ave, Memphis, TN, 38104. Fax: (901) 577-7430; E-mail: khouzamrami@yahoo.com Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume24, Issue3March 2007Pages 276-278 RelatedInformation

Clinical CardiologyVolume 31, Issue 6 p. 284-285 Images in CardiologyFree Access Pulmonary Sarcoidosis with Pulmonary Hypertension, Fossa Ovalis Aneurysm and Interatrial Shunt Rami N. Khouzam, M.D., Corresponding Author Rami N. Khouzam, M.D. Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, And Memphis VA Medical Center, Memphis, TN, USA1030 Jefferson Ave. Memphis, TN, 38104 USASearch for more papers by this authorIvan A. D'Cruz, M.D, F.R.C.P., Ivan A. D'Cruz, M.D, F.R.C.P. Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, And Memphis VA Medical Center, Memphis, TN, USASearch for more papers by this authorDaniel P. Minderman, R.D.C.S., Daniel P. Minderman, R.D.C.S. Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, And Memphis VA Medical Center, Memphis, TN, USASearch for more papers by this author Rami N. Khouzam, M.D., Corresponding Author Rami N. Khouzam, M.D. Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, And Memphis VA Medical Center, Memphis, TN, USA1030 Jefferson Ave. Memphis, TN, 38104 USASearch for more papers by this authorIvan A. D'Cruz, M.D, F.R.C.P., Ivan A. D'Cruz, M.D, F.R.C.P. Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, And Memphis VA Medical Center, Memphis, TN, USASearch for more papers by this authorDaniel P. Minderman, R.D.C.S., Daniel P. Minderman, R.D.C.S. Department of Internal Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, And Memphis VA Medical Center, Memphis, TN, USASearch for more papers by this author First published: 13 June 2007 https://doi.org/10.1002/clc.20028AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. References 1Skold CM, Larsen FF, Rasmussen E, Pehrsson SK, Eklund AG. Determination of cardiac involvement in sarcoidosis by magnetic resonance imaging and Doppler echocardiography. J Intern Med 2002; 252: 465– 471. Volume31, Issue6June 2008Pages 284-285 ReferencesRelatedInformation

The entity of effusive constrictive pericarditis (ECP) combines clinical and echocardiographic features of pericardial effusion and constrictive pericarditis. We describe a case of ECP, of probable tuberculous etiology, with typical hemodynamic findings of pericardial constriction, which persisted after the pericardial effusion was drained. Thickening of parietal and visceral pericardium was seen on 2D and 3D echo, and on MRI. Two important variations of ECP—due to tuberculous and to staphylococcal etiology, respectively—show some important differences that are relevant to management of therapy.

HomeCirculationVol. 116, No. 11Cardiac Tamponade With Fibrin Strands Leading to the Diagnosis of Systemic Lupus Erythematosus Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessReview ArticlePDF/EPUBCardiac Tamponade With Fibrin Strands Leading to the Diagnosis of Systemic Lupus Erythematosus Rami N. Khouzam, Daniel Minderman, Ahmad Munir and Ivan A. D'Cruz Rami N. KhouzamRami N. Khouzam From the Department of Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, and Memphis VA Medical Center, Memphis, Tenn. , Daniel MindermanDaniel Minderman From the Department of Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, and Memphis VA Medical Center, Memphis, Tenn. , Ahmad MunirAhmad Munir From the Department of Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, and Memphis VA Medical Center, Memphis, Tenn. and Ivan A. D'CruzIvan A. D'Cruz From the Department of Medicine, Division of Cardiovascular Diseases, University of Tennessee Health Science Center, and Memphis VA Medical Center, Memphis, Tenn. Originally published11 Sep 2007https://doi.org/10.1161/CIRCULATIONAHA.107.709097Circulation. 2007;116:e342–e344A 59-year-old male with an unremarkable past medical history presented with worsening dyspnea and a history of chest tightness for 2 weeks. He had arthritis of multiple hand and foot joints bilaterally. Muffled heart sounds and pulsus paradoxus of 15 mm Hg were noted on examination. Laboratory findings were remarkable for anemia, with a hemoglobin level of 8.9 g/dL (normal, 13.5 to 17 g/dL), proteinuria level of 0.9 g/d, positive antinuclear antibody level of 906 U/mL (normal, 0 to 99 U/mL), and positive anti-DNA (DS and SS) antibodies. A chest x-ray showed a large cardiac silhouette. A 2-dimensional transthoracic echocardiogram revealed a large circumferential pericardial effusion (Figure 1, asterisks), with remarkable intrapericardial adhesions (fibrin strands) that had a worm-like appearance and were partially attached and floating between the visceral and parietal pericardium (Figure 1 and Data Supplement Movie). Download figureDownload PowerPointFigure 1. Two-dimensional transthoracic echocardiogram in the apical 4-chamber view of the heart and modified apical views revealed a large circumferential pericardial effusion (asterisks), with intrapericardial adhesions (fibrin strands) partially attached and floating between the visceral and parietal pericardium. RA indicates right atrium; RV, right ventricle; LV, left ventricle; and a, apex of the heart.Pericardiocentesis was performed to drain 1700 mL of bloody fluid. Posteroanterior chest x-ray (Figure 2) showed the heart before (left) and after (right) pericardiocentesis. An ECG (Figure 3) before (upper) and after (lower) pericardiocentesis is shown. Download figureDownload PowerPointFigure 2. Posteroanterior chest x-ray showing the heart before (left) and after (right) pericardiocentesis.Download figureDownload PowerPointFigure 3. ECG before (upper) and after (lower) pericardiocentesis.The final diagnosis of systemic lupus erythematosus presenting with cardiac tamponade was made.The online-only Data Supplement, which contains a movie, can be found at http://circ.ahajournals.org/cgi/content/full/116/11/e342/DC1.DisclosuresNone.FootnotesCorrespondence to Rami Khouzam, MD, 480 Cerrillos Dr, Farmington, NM. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Maharaj S and Chang S (2015) Cardiac tamponade as the initial presentation of systemic lupus erythematosus: a case report and review of the literature, Pediatric Rheumatology, 10.1186/s12969-015-0005-0, 13:1, Online publication date: 1-Dec-2015. Maharaj S and Chang S (2015) Pericardial effusions in systemic lupus erythematosus — Who is most likely to develop tamponade?, International Journal of Cardiology, 10.1016/j.ijcard.2014.11.191, 180, (149-150), Online publication date: 1-Feb-2015. September 11, 2007Vol 116, Issue 11 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.107.709097PMID: 17846336 Originally publishedSeptember 11, 2007 PDF download Advertisement SubjectsEchocardiographyPericardial Disease

EchocardiographyVolume 23, Issue 10 p. 884-885 IMAGE SECTION Section Editor: Ivan D'Cruz, M.D. Aortic Regurgitation with Diastolic Aortic Valve Flutter in a Patient with Hypertrophic Cardiomyopathy Linus Wodi M.D., Linus Wodi M.D. University of Tennessee Health Science Center, and Memphis VA Medical Center, Memphis, TennesseeSearch for more papers by this authorRami N. Khouzam M.D., Rami N. Khouzam M.D. University of Tennessee Health Science Center, and Memphis VA Medical Center, Memphis, TennesseeSearch for more papers by this authorDaniel Minderman R.D.C.S., Daniel Minderman R.D.C.S. University of Tennessee Health Science Center, and Memphis VA Medical Center, Memphis, TennesseeSearch for more papers by this authorIvan A. D'Cruz M.D., F.R.C.P., Ivan A. D'Cruz M.D., F.R.C.P. University of Tennessee Health Science Center, and Memphis VA Medical Center, Memphis, TennesseeSearch for more papers by this author Linus Wodi M.D., Linus Wodi M.D. University of Tennessee Health Science Center, and Memphis VA Medical Center, Memphis, TennesseeSearch for more papers by this authorRami N. Khouzam M.D., Rami N. Khouzam M.D. University of Tennessee Health Science Center, and Memphis VA Medical Center, Memphis, TennesseeSearch for more papers by this authorDaniel Minderman R.D.C.S., Daniel Minderman R.D.C.S. University of Tennessee Health Science Center, and Memphis VA Medical Center, Memphis, TennesseeSearch for more papers by this authorIvan A. D'Cruz M.D., F.R.C.P., Ivan A. D'Cruz M.D., F.R.C.P. University of Tennessee Health Science Center, and Memphis VA Medical Center, Memphis, TennesseeSearch for more papers by this author First published: 14 September 2006 https://doi.org/10.1111/j.1540-8175.2006.00332.x Address for correspondence and reprint requests: Ivan A. D'Cruz, M.D., Cardiology Section, VA Medical Center, 1030 Jefferson Ave, Memphis, TN 38104. Fax: (901) 577-7430; E-mail: [email protected] Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. References 1 Theard MA, Bhatia SJ, Plappert T, et al: Doppler echocardiographic study of the frequency and severity of aortic regurgitation in hypertrophic cardiomyopathy. Am J Cardiol 1987; 60: 1143– 1147. 2 Kar AK, Roy S, Panja M: Aortic regurgitation in hypertrophic cardiomyopathy. J Assoc Physicians India 1993; 41: 576– 578. 3 Estevez CM, Dillon JC, Walker PD, et al: Echocardiographic manifestations of aortic cusp rupture in a myxomatous aortic valve. Chest 1976; 69: 685– 687. 4 Whipple RL 3rd, Morris DC, Feiner JM, et al: Echocardiographic manifestations of flail aortic valve leaflets. J Clin Ultrasound 1977; 5: 417– 422. Volume23, Issue10November 2006Pages 884-885 ReferencesRelatedInformation

Under certain abnormal conditions, part or all of the stomach can migrate through the diaphragm into the thorax. These conditions include congenital defects in the diaphragm and traumatic rupture of the diaphragm (commonly resulting from automobile accidents). A more common cause of partial translocation of the stomach into the chest is a sliding hernia through the esophageal hiatus itself. Intrathoracic stomach can also be iatrogenic; in this article, the authors describe the echocardiographic findings of a patient in whom carcinoma of the esophageal-gastric junction was resected and the cut ends of the esophagus and stomach anastomosed by bringing the stomach up into the thorax.