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A Prominent Pectinate Muscle Mimicking a Pathological Cardiac Mass

A 72-year-old male was admitted to our clinic because of chest pain and shortness of breath. Functional capacity of the patient was class II according to NYHA classification. On physical examination a grade 4/6 systolic murmur was heard at the apex of the heart. There was no history of thromboembolism, palpitations, or atrial fibrillation. Transthoracic echocardiography revealed severe mitral regurgitation due to mitral valve prolapsus. Transesophageal echocardiography (TEE) examination revealed a 10 mm pedunculated mass attached to the tip of the left atrial appendage (LAA). The mass was well demarcated and centrally echolucent (Fig. 1; Video clip 1). LAA flow velocity was 44 cm/sec, which was mildly reduced. Spontaneous echocontrast effect was not seen in the LAA. It was unclear whether the mass represented a prominent pectinate muscle, thrombus or an unusually located cardiac papillary fibroelastoma or myxoma. The patient was scheduled for mitral valve replacement because of severe mitral regurgitation. The mass in LAA was examined during operation and reported as a prominent pectinate muscle. This is a case of an unusual echocardiographic appearance of a prominent pectinate