Flash contrast

Get Closer to the Diagnosis in a Flash
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Circulation: Cardiovascular Imaging
Issue: Volume 5(2), March 2012, p 280–282
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A 15-year-old girl of Middle East origin was seen by a pediatrician because of suspected pituitary nanismus.
She had no cardiopulmonary symptoms, but the examination revealed a large nonobstructive, mobile, and apparently multicystic mass in the right ventricle.
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All blood tests were normal including her infectious parameters, and she did not have serum antibodies to any Echinococcus species. An FDG PET-CT scan did not show any particular FDG activity in the mass. Cardiac magnetic resonance showed no signs of tumor infiltration into the myocardium, a feature supporting the suggestion of a benign tumor (Figure 3). It was decided to perform a flash-contrast echocardiography to elucidate the vascularity of the mass and the cyst-like structures (Figure 4). For the contrast echocardiography, a Vivid 7 (GE, Horten, Norway) ultrasound scanner was used, equipped with a 2.5-MHz probe. The echocontrast agent (Sonovue, Bracco, Inc, Milan, Italy; diluted in 10 mL isotonic sodium chloride) was administered intravenously with isotonic sodium chloride (approximately 250 mL/h) at constant rate (approximately 1 mL/min), which kept the contrast dissolved during the infusion. The scanner was adjusted to a low mechanical index to diminish contrast disruption, followed by short bursts of high mechanical index to destroy the contrast in the field of view, including the tumor (Figure 3B). During 15 consecutive heart beats, the perfusion in the tumor was semiquantitatively assessed by comparing contrast replenishment in the interventricular septum with contrast replenishment in the tumor.
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