A left atrial pseudomass: potential pitfall at thoracic MR imaging

We frequently observed a nodular soft-tissue structure in the region of the left atrium anterior to the orifice of the left inferior pulmonary vein on MR scans of the chest. To assess its morphologic characteristics and appearance, chest MR scans obtained in 49 patients were reviewed. ECG-gated conventional spin-echo T1-weighted and fast spin-echo (FSE) T2-weighted sequences were used. The location, morphology, and appearance of this soft-tissue structure was evaluated by two radiologists during one consensus reading. The pseudomass in the region of the left atrium was identified on the T1-weighted images in 25 of 49 patients. The structure was also identified on FSE T2-weighted images in 6 of these patients. On the T1-weighted images, its appearance was either linear (54%) or nodular (46%). In conclusion, a nodular soft-tissue mass anterior to the orifice of the left inferior pulmonary vein into the left atrium is a frequent finding on chest MR scans and should not be confused with an intra-atrial mass. Careful evaluation of the regional anatomy identifies this structure as extraluminal and helps to avoid misinterpretation of an intracardiac mass.