A 43-year-old male presented with chest trauma after a fall. A trans-thoracic echocardiogram revealed a 1 cm mass protruding into the left ventricular outflow tract. Cardiac MRI was obtained for better tissue characterization. The MRI showed the mass had a non-enhancing morphology. Based on the echocardiogram and MRI findings, the mass was determined to be a sub-aortic membrane. The patient was discharged with regular follow up since he did not have a significant gradient across the membrane or aortic regurgitation.

1. SUB-AORTIC MEMBRANE:
ROLE OF MULTI-MODALITY IMAGING
Ruchit Shah, M.D.
Cardiology Fellow
Medical College of Georgia at Augusta University

2. CASE
 43 year-old male without a significant past medical history
presented with sustained chest trauma after falling from a
tree. A trans-thoracic echocardiogram (TTE) was obtained to
assess for a cardiac contusion or pericardial effusion, which
revealed a mass protruding into the left ventricular outflow
tract (LVOT) measuring about 1 cm.

3. TRANSTHORACIC ECHOCARDIOGRAM IMAGES

4. TRANSTHORACIC ECHOCARDIOGRAM IMAGES (CONT.)

5. TRANSTHORACIC ECHOCARDIOGRAM IMAGES (CONT.)

6. TTE CHARACTERISTICS OF THE SUB-AORTIC MASS
 Mass had a broad base with a different echo density as
compared to the anteroseptum
 It did not connect with either the aortic or mitral valve
 There was no aortic regurgitation
 There was no significant gradient at rest or with Valsalva across
the mass
 ?Sub-aortic membrane
 Usually have a narrow base
 Same echo density as anteroseptum
 Differential d/x for this mass also included fibroma, lipoma, and myxoma

7. CARDIAC MRI
 Cardiac MRI
 Obtained for better tissue characteristics
 Morphology
 T1-Weighted enhancement images (with contrast)
 Based on cardiac MRI characteristics can narrow down the of the
mass

8. CARDIAC MRI IMAGES

9. CARDIAC MRI IMAGES (CONT.)

10. CONCLUSION
 Based on the morphology and non-enhancement of sub-aortic
mass from the cardiac MRI, the mass was likely a sub-aortic
membrane
 Given that patient did not have a significant gradient across the
sub-aortic membrane, there was no aortic regurgitation, and the
patient had normal LV systolic dimensions and ejection fraction,
he was discharged home with regular follow up in cardiology
clinic
 Cardiac MRI is extremely valuable for tissue characterization
when diagnosis by echocardiogram cannot be easily made

11. ACKNOWLEDGEMENTS
 Gyanendra Sharma, M.D. – Director of Echocardiogram
Laboratory, Professor of Medicine, Division of Cardiology
 Jayanth H. Keshavamurthy, M.D. – Assistant Professor of
Radiology
 Kevin C. Dellsperger, M.D.,Ph.D. – Associate Dean of
Clinical Affairs, Chief Medical Officer

12. QUESTIONS?