Straight back syndrome can cause external compression of the heart and great vessels, masquerading as a cardiac mass on echocardiography, which can be accurately diagnosed using cardiac MRI.
A 40-year-old woman with no noteworthy medical history presented with palpitations, atypical chest tightness, and near-syncope. Two-dimensional transthoracic echocardiograms showed a small left atrium (Fig. 1); external compression from a mass was suspected. Cardiac magnetic resonance images revealed no masses (Fig. 2). However, there was a loss of normal thoracic kyphosis (Fig. 3), and the left atrium was abnormally small and elongated because of external compression from the thoracic spine. The diagnosis was straight back syndrome. Fig. 1. Two-dimensional echocardiograms in A) parasternal long-axis and B) apical 4-chamber views show a small left atrium (LA). Fig. 2. Magnetic resonance image (left ventricular outflow tract view) shows a small left atrium (LA) with no evidence of compression by an external mass. Fig. 3. Magnetic resonance image shows a straight spine with loss of thoracic kyphosis.
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Almanfi et al. (2016) studied this question.
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