Bearing in mind the intricacies of the human heart, let’s delve into its anatomy. The heart, a vital organ with four key openings, harbors a structure known as the crista terminalis within its right atrium. This feature forms a dividing ridge in the atrium, separating it into a section with a complex network (trabeculated right atrial appendage) and a smoother part (sinus venosus). Although crucial, its size and appearance can widely vary, creating potential confusion in medical imaging. Interestingly, about 40% of people have a noticeable crista terminalis, with a higher occurrence in women. This often overlooked anatomical detail can lead to significant misinterpretations, especially in sophisticated imaging techniques.
The study, led by Dr. Busra Cangut and her team, Dr. Lewen Stempler and Aiden Ghesani from the Icahn School of Medicine at Mount Sinai, New York, emphasizes the need to correctly identify normal and non-harmful uptakes in heart. The findings, published in the peer-reviewed journal “Radiology Case Reports,” bring to light the risks of incorrect diagnosis and the vital role of precise interpretation in medical imaging.
Dr. Busra Cangut details, “An 18F-FDG (a type of radioactive glucose) PET/CT scan, conducted to determine the stage of the cancer, showed intense activity in the right atrium resembling prominent soft tissue. A subsequent deeper examination using transesophageal echocardiography (TEE) ultimately confirmed that what was seen is actually a prominent crista terminalis, a common variation in heart anatomy”. The research focuses on a 79-year-old woman, newly diagnosed with breast cancer. Her 18F-FDG PET/CT scan, part of her cancer assessment, unexpectedly revealed significant activity in her right atrium, initially suggesting a possible dangerous mass. This concerning observation led to further in-depth evaluations, which clarified as a prominent crista terminalis, a typical variation in cardiac structure.
“The crista terminalis is located in the right atrium, running along the side wall between two major veins, the superior and inferior vena cava. In some instances, the normal activity of F-18 FDG in the crista terminalis can be wrongly identified as a tumor thrombus, as happened in our case. Therefore, it’s crucial to deeply understand normal uptakes in standard heart structures and their variations when analyzing these images,” Dr. Cangut underscores. This study is significant in showing the challenges of interpreting these images accurately. The crista terminalis can display activity that might be mistaken for a sign of tumor thrombus, a concern in cancer patients. The research stresses the importance of thoroughly understanding normal physiologic uptake and benign variations in standard cardiac structures to prevent wrong interpretations.
These findings are especially important for medical professionals. They highlight the need for careful examination and interpretation of imaging results, with a consideration for benign variations. Such awareness can reduce unwarranted worry for patients and doctors, prevent unnecessary additional imaging procedures, and guarantee timely and suitable care. In sum, this study serves as a reminder of the complexities and subtleties in medical imaging. It underscores the need for detailed scrutiny in interpreting scans to accurately differentiate between harmful and harmless findings. This particular case illustrates the saying “not everything that shines is gold,” emphasizing the need to consider normal heart variations when making diagnoses.
JOURNAL REFERENCE
Aiden Ghesani, Busra Cangut, Lewen Stempler, “Not everything that shines is gold, normal uptake in crista terminalis on FDG PET:CT masquerading as a tumor thrombus approaching right heart”, Radiology Case Reports, 2024. DOI: https://doi.org/10.1016/j.radcr.2023.10.068.
ABOUT THE AUTHOR
Dr. Busra Cangut‘s journey through medical education and research has been rich and diverse. She earned her medical degree from Istanbul-Marmara University School of Medicine. While in medical school, she did clerkships at prestigious institutions including Harvard, Cleveland Clinic, and at the University of Texas, cardiac surgery departments. After medical school , she joined Mayo Clinic Cardiac Surgery Department as Postdoc Research Fellow where she dedicated a year to basic science research, focusing primarily on mouse models in Advanced Atherosclerotic Plaque Composition. Subsequently, during her postdoctoral fellowship, she contributed to a clinical trial comparing different aortic valve bioprostheses.
Her academic pursuits continued with a master’s degree in clinical and translational science and a general surgery intern year at Mayo Clinic. Currently, Dr. Cangut is at Mount Sinai Hospital/New York, where she is deeply involved in advancing cardiac imaging technologies tailored to specific valve pathologies. Her work encompasses a multifaceted approach to cardiothoracic surgery, integrating basic science, clinical expertise, and imaging modalities to provide a comprehensive understanding of the field.
Dr. Cangut’s research interests are centered around cutting-edge cardiac imaging technologies, particularly the exploration of PET/MRI applications for specific valve pathologies. Additionally, she has been awarded the ERAS Cardiac Fellowship Award, which is dedicated to optimizing perioperative care for cardiac surgery patients. She is actively developing order sets aimed at facilitating the widespread and seamless implementation of evidence-based perioperative care protocols, with the ultimate goal of improving patient outcomes. Driven by her passion for academic excellence, Dr. Cangut aspires to become an academic cardiac surgeon. Her vision involves leveraging cardiac imaging for surgical planning and deepening the understanding of disease pathologies and their impact on the heart through advanced imaging technologies.
