LOOPS for thought: identifying gastrointestinal pathology on transthoracic echocardiography

Transthoracic echocardiography (TTE) is the most commonly used modality for the diagnosis and follow-up of cardiac diseases. During routine TTE, surrounding extracardiac structures are often visualized, including the lungs, pleural spaces, oesophagus, diaphragm, and sub-diaphragmatic structures such the liver, stomach, bowel, and abdominal aorta. Pathologic conditions affecting these organs may exert extrinsic compression on the cardiac chambers, leading to diagnostic uncertainty or mimicking cardiac disease by producing symptoms, such as dyspnoea, fatigue, chest pain, or palpitations.

We describe five patients who underwent routine TTE and were incidentally found to have unsuspected gastrointestinal abnormalities. The findings subsequently confirmed by other imaging modalities included hiatal hernia, distended bowel loops, oesophageal carcinoma, and oesophageal varices. Reporting of these findings impacted the diagnosis and management of the cases.

Awareness of the sonographic appearance of gastrointestinal during TTE is essential, as these findings may represent clinically significant pathology that mimics or contributes to cardiac symptoms. Recognition of such findings may be enhanced by modified echocardiographic views, with confirmatory evaluation using chest radiography, computed tomography, or gastrointestinal endoscopy as appropriate.