Artifacts are frequently encountered during echocardiographic examinations. An understanding of the physics and underlying assumptions of ultrasound processing involved with image generation is important for accurate interpretation of 2D grayscale, spectral Doppler, color flow Doppler, and 3D artifacts and their clinical implications.

March 2016 • Volume 122 • Number 3 www.anesthesia-analgesia.org 633 Copyright © 2016 International Anesthesia Research Society DOI: 10.1213/ANE.0000000000001085 Artifacts are common during echocardiography. An artifact is information contained in a displayed image that leads to an incorrect depiction of the true anatomy. The increased complexity in the interpretation of artifacts has been part of the ongoing debate on the importance of proper training and credentialing for echocardiography.1,2 For example, artifacts in the ascending aorta occurred in 46% of patients with suspected aortic dissections studied by transesophageal echocardiography (TEE).3 The misinterpretation of an artifact as a true finding may lead to unnecessary or omitted interventions, including medical treatment and surgery.4,5 This review is intended to discuss artifacts by providing examples, reviewing the ultrasound physics behind their generation, and suggesting how to reduce or eliminate them.