Cardiac lipomas are benign rare neoplasms of the heart. They are encapsulated and well defined subendocardial or subepicardial masses that can be seen at the atrial or ventricular level. Unlike cardiac thrombus and other tumors, lipomas have low tendency to develop peripheral emboli. Although transesophageal echocardiogram (TEE) is the procedure of choice to evaluate for atrial thrombus and masses, it might be difficult to conclude a diagnosis especially in the left atrial appendage. Cardiac imaging is essential to differentiate left atrial appendage lipomas (LAAL) from other tumors and thrombi to avoid unnecessary intervention. We report the first case of LAAL found incidentally by intraoperative TEE.

Partial anomalous pulmonary venous connection (PAPVC) with intact interatrial septum is an uncommon congenital anomaly, while isolated left pulmonary venous connection with intact interatrial septum is rare. In this report, a 5-year-old girl with chief complains of mild short breath after exercise was diagnosed of anomalous connection between left superior pulmonary vein (LSPV) and left innominate vein by transthoracic echocardiography (TTE) that was confirmed by 3D cardiac CT scanning.

Isolated Pulmonary vein stenosis (PVS) in adults is a rare condition, especially in absence of associated congenital heart disease. We report PVS of left sided pulmonary veins in an 18 year old male, who until then had been mistakenly diagnosed as primary pulmonary hypertension (PPH). The case highlights the fact that evaluation for pulmonary vein stenosis is essential for all patients with severe unexplained pulmonary.

Residual patent ductus arteriosus (PDA) after surgical ligation is not common and it may be distorted by the surgery resulting in a difficult transcatheter closure. Such distorted anatomy of the duct may not be demonstrated by the two-dimensional transesophageal echocardiography (2D TEE), but live 3D TEE provided the precise anatomy of the elongated distorted residual duct. In the case presented herein, live 3D TEE provided novel images of complex residual duct and successful guidance of the Amplatzer ductal occluder (ADO) deployment.

We present a 63-year-old man who presented with chest discomfort and breathlessness on exertion. Echocardiography revealed a D'Cruz Type II left atrial compression by giant descending thoracic aortic aneurysm. The echocardiographic assessment of this condition is highlighted.

A young woman with a mechanical mitral prosthetic stenosis underwent multiple imaging modalities including fluoroscopy, two-dimensional transthoracic and transesophageal echocardiography and real time three-dimensional transesopahgeal echocardiography (3D TEE) to determine the cause of her stenosis. Only 3D TEE demonstrated the full size and extent of an obstructing mass on the strut and sewing ring of the prosthetic mitral valve.