An 85-year-old female came in with complaints of chest pain. Her past history is significant for coronary artery disease, diabetes mellitus, and partial left mastectomy for a stage 2 breast cancer 6 years ago. Her lab work was negative for any acute process. She has a history of drug-eluting stent placement to her left circumflex artery 6 months prior to this admission. She has a nuclear stress test which was negative for ischemia. She also underwent an echocardiogram as part of her workup. What does the image in Figure 24.1 show?

1. Normal
   
2. Enlarged liver
   
3. Cysts in the kidney
   
4. Mass in the liver

What is the next best step for the patient in Question 24.1?

1. Nothing at this time as she has no abdominal complaints
   
2. Aspiration biopsy of the liver mass
   
3. Ultrasound of the liver
   
4. CT scan of the liver

A 33-year-old female presented with complaints of shortness of breath, choking sensation, and facial swelling. She has a history of a vaginal delivery 4 weeks ago prior to this presentation. She denies any other medical problems in the past. An echocardiogram was performed. What does the image in Figure 24.3 show?

1. Normal echocardiogram from the suprasternal window
   
2. An artifact
   
3. Large mass in the superior mediastinum
   
4. Cannot tell

What is the next step for the patient in Question 24.3?

1. Diagnostic imaging with computed tomography (CT) scan
   
2. Ultrasound of the neck
   
3. No need for additional imaging
   
4. PET scan

A CT scan, shown in Figure 24.5, was ordered for the patient in Question 24.3. What does the image show?

1. Mass in the anterior mediastinum
   
2. Mass in the posterior mediastinum
   
3. Mass in the lung
   
4. Nothing abnormal is seen

What is the next best step for the patient in Question 24.3?

1. Biopsy of the mass
   
2. Ultrasound of the mass
   
3. Consultation with a surgeon
   
4. Nothing at this time

A 31-year-old male is admitted to the hospital for complaints of hemoptysis. He is a prisoner, and has a remote history of tuberculosis that was treated. An echocardiogram was performed. What does the still frame obtained from parasternal long axis view and subcostal view in Figure 24.7a show?

1. Mass in the left atrium
   
2. Mass in the right atrium
   
3. Large artifact
   
4. No abnormality is noted

The patient in Question 24.7 then underwent cardiac magnetic resonance imaging. The SSFP image is shown in Figure 24.8a. What does this image show?

1. Mass in the left atrium
   
2. Mass in the left atrium with filling defect in the right lower pulmonary vein and bilateral pleural effusions
   
3. No cardiac abnormality is noted
   
4. Mass in the right atrium

The patient in Question 24.7 also then started having hemoptysis, for which a CT scan was done. What does the image in Figure 24.9a show?

1. Normal CT scan of the chest
   
2. A mass encircling the right bronchus
   
3. Mass in the pulmonary artery
   
4. Mass in the liver

The patient in Question 24.7 then started complaining of left thigh pain and swelling. A CT scan of the lower extremities was completed; see Figure 24.10a . What does the image show?

1. A normal CT scan
   
2. Normal right thigh and a large mass in the left thigh
   
3. A large mass in the lower abdomen
   
4. Mass in the right thigh

What is the next best step for the patient in Question 24.7?

1. Consultation with the surgeons to remove the left atrial tumor
   
2. Biopsy of the left thigh mass
   
3. Biopsy of the left atrial mass
   
4. Surgical consultation to remove the left thigh mass

A 72-year-old male presented with a history of mechanical mitral valve replacement for rheumatic heart disease. He was on a therapeutic dose of warfarin and had subdural hemorrhage. Warfarin was discontinued by his treating physicians. The cardiologist paged late Friday evening for assistance as the patient went into flash pulmonary edema, atrial fibrillation with rapid ventricular response, was intubated emergently and imaging was performed; see Figure 24.12a. What does the image show?

1. Vegetations
   
2. Pannus
   
3. Tumor masses
   
4. Thrombus

A 74-year-old male was being evaluated for complaints of shortness of breath. His echo was unremarkable except for the image shown in Figure 24.13a. What does the image show?

1. Normal subcostal view
   
2. Artifact in the inferior vena cava (IVC)
   
3. Discrete masses in the IVC
   
4. Discrete masses in the aorta

What is the next best step for the patient in Question 24.12?

1. Do nothing
   
2. Ultrasound of the abdomen
   
3. Magnetic resonance imaging of the abdomen
   
4. Initiate anticoagulation

A 64-year-old male was admitted to hospital with complaints of fever, fatigue, and night sweats. He had a transthoracic echocardiogram; see Figure 24.15a. What does this left-sided subcostal image show?

1. Normal structures
   
2. Nephromegaly
   
3. Hepatomegaly
   
4. Splenomegaly

A 20-year-old male presents to the hospital with complaints of fever, chills, and loss of appetite. He has a history of endocarditis and had a history of tricuspid valve replacement about 2 years prior to this admission. On examination he was febrile and tachycardiac. He had an echocardiogram; see Figure 24.16a. What does the image show?

1. Normal native tricuspid valve
   
2. Vegetations on the bioprosthetic valve
   
3. Tumor masses
   
4. Thrombus on the valve

A 34-year-old male presents with complaints of malaise and shortness of breath on exertion. Physical examination is otherwise unremarkable. He had an echocardiogram; see Figure 24.17a (LA: left atrium; LV: left ventricle; RA: right atrium; RV: right ventricle). What does the image show?

1. Thrombus
   
2. Myxoma
   
3. Sarcoma
   
4. Vegetation

A 45-year-old female had sudden onset of palpitations and had near syncope. She had no significant past medical history. She had an echocardiogram; see Figure 24.18a (LV: left ventricle; RV: right ventricle). What does the image show?

1. Myxoma
   
2. Rhabdomyoma
   
3. Fibroma
   
4. Lymphoma

A 56-year-old male presents to the hospital with a history of transient ischemic attack. On examination he has no motor or sensory deficits. His cardiac examination is normal. He had an echocardiogram; see Figure 24.19a. What does the image show?

1. Vegetation on the mitral valve
   
2. Papillary fibroelastoma of the aortic valve
   
3. Papillary fibroelastoma of the mitral valve
   
4. Thrombus on the aortic valve

A 35-year-old male with a history of long-standing type 2 diabetes mellitus, hypertension, and end-stage renal disease started dialysis 2 months ago. He presents to the hospital complaining of fever, chills, malaise, nausea, and loss of appetite. He was clammy to touch, tachycardiac, and febrile. The rest of his physical examination was normal. He had blood cultures drawn and had an echocardiogram; see Figure 24.20a. What does the image show?

1. Vegetation on the catheter
   
2. Thrombus
   
3. Tumor mass
   
4. Nothing abnormal is detected

What is the initial management strategy for the patient in Question 24.20?

1. Start antibiotics
   
2. Draw blood cultures, one from the periphery and one from the line, and then start antibiotics
   
3. CT scan of the chest
   
4. Observation

What does the image in Figure 24.22a show?

1. Vegetation
   
2. Thrombus
   
3. Blood cyst
   
4. Tumor

A 75-year-old patient with a history of hypertension had an echocardiogram at an outside hospital. The patient was referred to this hospital for evaluation of a right atrial mass. What does the image in Figure 24.23a (LA: left atrium; RA: right atrium) show?

1. Lymphoma
   
2. Sarcoma
   
3. Thrombus
   
4. Lipomatous hypertrophy of the interatrial septum