European Journal of Echocardiography 2008 9(2):296-297; doi:10.1016/j.euje.2006.10.006
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2006. For permissions please email: journals.permissions@oxfordjournals.org
Impairment of echocardiographic acoustic window caused by breast implants
Mohammad-Reza Movahed*
Department of Medicine, Section of Cardiology, University of Arizona Sarver Heart Center and the Southern Arizona VA Health Care System, 1501 North Campbell Avenue, Tucson, AZ 85724, USA
Received 14 August 2006; accepted after revision 20 October 2006; online publish-ahead-of-print 8 December 2006.
* Corresponding author. Tel: + 1 520 626 6223; fax: + 1 520 626 5181. E-mail address: rmovahed{at}email.arizona.edu
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Abstract
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Cosmetic breast implants are increasing in popularity. The presence
of a breast implant overlying the anterior mediastinal space
as a cause of impairment of the echocardiographic acoustic window
has not been described previously. Here, we report three cases
with significant impairment of echocardiographic acoustic window
caused by breast implants. Clinicians should be aware of this
interference and women should be informed of this dilemma before
considering this cosmetic surgery.
Keywords: Breast implant; Echocardiography; Attenuation; Silicone implant; Saline implant; Acoustic window
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Introduction
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Any obstacle that creates a poor acoustic window would substantially
limit the ability of echocardiography in the assessment of cardiac
structures and function. The presence of a foreign object overlying
the anterior mediastinum can markedly impair the acoustic window.
There are no reports in the literature describing any interference
of breast implants with echocardiographic image acquisition.
Here, we report three cases with impaired acoustic windows and
poor image quality caused by their breast implants.
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Case 1
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This patient is a 52-year-old female with a past medical history
of recurrent paroxysmal supraventricular tachycardia. Echocardiography
was ordered for the assessment of her cardiac function. The
technician performing her echocardiography had a great difficulty
in obtaining adequate image quality of her interventricular
septum and right ventricular cavity particularly in the parasternal
long axis view. The artifact was caused by the silicone breast
implant obscuring the left ventricular cavity (
Figure 1).
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Case 2
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This patient underwent echocardiography for the evaluation of
shortness of breath. There was a marked limitation of her acoustic
window. The image artifact secondary to her silicon breast implant
obscured her right and left ventricular cavities in the apical
four-chamber view (
Figures 2 and
3).
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Figure 2 Silicone breast implant caused a large artifact (arrow) obscuring both ventricular structures in the apical four-chamber view (LV = left ventricle, RV = right ventricle, LA = left atrium, RA = right atrium).
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Case 3
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This patient was referred for echocardiographic examination
for the evaluation of her chest pain. Her echocardiogram revealed
a large artifact caused by her silicone breast implant limiting
the visualization of her valves in the parasternal short axis
view (
Figure 4).
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Discussion
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Breast implants as a cause of marked attenuation during cardiac
gated SPEC studies have recently been reported.
1–3 However,
there are no reports on the effect of breast implants on the
echocardiographic acoustic window. As the popularity of cosmetic
surgery rises, the incidence of female patients with breast
implants undergoing echocardiography will increase.
4,5 It is
important for the women to be aware that breast implants may
interfere with echocardiographic image acquisition making the
evaluation of heart disease difficult. All our cases had silicone
implants limiting our observation to breast implants containing
silicone.
Furthermore, the effect of the outer layer of breast implants on the image quality is not known.
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Conclusion
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Silicone breast implants could produce significant artifacts
during echocardiographic examination of the heart. Clinicians
should be aware of this problem and women should be educated
about the potential future diagnostic limitations that could
occur as a result of having breast implants when they are considering
breast augmentation.
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References
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- Caner B, Ozgur F, Bor D, Ulutuncel N, Aydin M, Sari O. Effect of silicone breast implants on myocardial imaging. Ann Plast Surg (1999) 43:471–5.[CrossRef][Web of Science][Medline]
- Meine TJ, Patel MR, Heitner J, Fortin TA, Pagnanelli RA, Gehrig TR, et al. Cardiac imaging impaired by a silicone breast implant. Clin Nucl Med (2005) 30:262–4.[CrossRef][Web of Science][Medline]
- Stinis C, Lizzote P, Movahed MR. Impaired myocardial SPECT imaging secondary to silicon- and saline-containing breast implants. Int J Cardiovasc Imaging (2006) 22:449–55.[CrossRef][Web of Science][Medline]
- Cook RR, Delongchamp RR, Woodbury M, Perkins LL, Harrison MC. The prevalence of women with breast implants in the United States—1989. J Clin Epidemiol (1995) 48:519–25.[CrossRef][Web of Science][Medline]
- Le GM, O'Malley CD, Glaser SL, Lynch CF, Stanford JL, Keegan TH, et al. Breast implants following mastectomy in women with early-stage breast cancer: prevalence and impact on survival. Breast Cancer Res (2005) 7:R184–93.[CrossRef][Web of Science][Medline]
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Abstract
Introduction
