Two-dimensional echocardiographic features of atrial septal aneurysms

Aneurysms of the interatrial septum are rare. They have been associated with complications such as embolic phenomena and atrioventricular orifice obstruction. We describe two patients, one adult and one child, with atrial septal aneurysms that were diagnosed by real-time, two-dimensional echocardiography. Atrial septal aneurysms appeared as thin, localized outpouchings of the atrial septum that protruded into the right atrium and showed marked variations in their contour and size during the cardiac cycle. They could be differentiated from other intra-atrial structures such as tumor mass, large eustachian valve and intra-atrial baffle by their relatively low reflectance, relationship to the atrial septum, considerable alterations in their outline during the cardiac cycle and characteristic patterns during peripheral venous contrast echocardiography.