Cardiac masses: an integrative approach using echocardiography and other imaging modalities
Bibliographic record
Abstract
Echocardiography has been and remains an invaluable tool for cardiac evaluation, including characterisation of cardiac masses. Even if most cardiac masses are considered benign, significant morbidity related to obstruction, infiltration, thromboembolism, arrhythmias and even death may occur. Therefore, a rapid and precise diagnosis is mandatory. Echocardiography enables key questions regarding the mass to be answered, such as: location, size, mobility, haemodynamic consequences and differentiation with extra-cardiac disease, embryologic remnants or artefacts. Recent advances in computed tomography (CT) and cardiac magnetic resonance (CMR) may help in the further characterisation of cardiac masses. This article presents challenging cases encountered at the Montreal Heart Institute between 2005 and 2008; we discuss the differential diagnosis of each mass and the current role of echocardiography, cardiac CT, and cardiac MRI (table 1). View this table: Table 1 Evaluation of seven cardiac masses through transthoracic echocardiography (TTE), transoesophageal echocardiography (TOE), cardiac magnetic resonance imaging (CMR), and computed tomography (CT) scan A middle age person underwent an uneventful left atrial myxoma resection many years ago, without any residual mass on follow-up transthoracic echocardiography (TTE) performed 1 year after. A few months later' however, she complained of non-specific symptoms of fatigue, shortness of breath, and atypical chest pain. Symptoms such as fever, weight loss or neurological problems were denied. Physical examination, ECG and chest x-ray were normal. Repeat TTE (figure 1, video 1) depicted a sessile bi-lobar, non-obstructive and immobile mass in the left atrium, with suspected right atrium extension. A transoesophageal echocardiogram (TOE) confirmed the 11×9 mm slightly mobile mass attached posteriorly to the interatrial septum, on the left atrial side. A recurrent myxoma was suspected, but neither a thrombus nor a sarcoma could be excluded, given the rapid growth of this mass. CMR further delineated this left atrial irregular mass, originating from the interatrial septum, hypointense on T1 weighted and hyperintense …
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.007 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.005 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".