Left atrial appendage: real-time three-dimensional transthoracic echocardiographic image.

This fact becomes especially relevant when anatomical observation translates into prognostic clinical implications, such as in the identification of images of thrombi in the left atrium or left atrial appendage. In most clinical situations, the investigation of intra-atrial images of thrombi with the use of two-dimensional transthoracic echocardiography does not allow anatomical information reliable enough for a diagnostic definition. Use of multiplane bidimensional transesophagic echocardiography enabled additional diagnostic information for discrimination of intra-atrial masses caused by the use of transducers with a greater ultrasound emission frequency, at a greater proximity to the structure of interest, providing images with a better quality of structural definition. Nevertheless, this semi-invasive echocardiographic modality does not yet allow structural from all anatomic planes of observation (a primary limitation for structural identification based on frontal and transversal cardiac planes, with observation point in atrioventricular, pulmonary, and aortic valve rings).