Imaging the left atrial appendage using TTE

Squeezing more out of imaging

The standard views that are recommended in the guidelines are an important part of learning and standardizing echocardiography. But sometimes I wonder who came up with exactly these views? While I agree that the standard views were well chosen I am convinced that it will always be necessary to use atypical views that focus on the pathology or the structure you want to study.

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Visualizing the left atrial appendage

Routinely we rarely look at the left atrial appendage. But there are situations where it makes sense. But do YOU know how to find the left atrial appendage? Here is an example of how you can use a standard view and then optimize the image to display the left atrial appendage. Let’s see if you know which standard view I mean?
Watch the “question-” and “answer videos“ taken from our Echo Skills Lab – Knowledge Trainer:

Question video

All you need to correctly answer the question is a good understanding of cardiac anatomy. Here is the answer video, which shows you several different views to image the left atrial appendage:

Answer video

Why can imaging the LAA be important?

Which information can we gain if we display the left atrial appendage? First patients with elevated left atrial pressure will commonly have an expanded left atrial appendage. This may be an indirect sign of diastolic dysfunction.

Second, the size of the left atrial appendage is a predictor of stroke. The larger (and deeper) the LAA is, the more likely it is that a thrombus will form. And finally, we can also detect thrombi in the LAA from a transthoracic approach. Here is such an example:

Modified 2 Chamber view – Thrombus located in a large left atrial appendage

Of course TEE is still the gold standard, when it comes to imaging the left atrial appendage. But remember we do not perform a TEE study in all of our patients.

If you are interested to expand your knowledge in an easy and fun way.
Sign up for our EchoSkill Lab Knowledge Trainer.

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