The papillary muscle may lead to a reduction of the penetrating ultrasound energy by reflection, scattering and absorption. Distal to the papillary muscle contrast medium may not be stiumulated to emit harmonic frequencies, resulting in a “shadow”. This can complicate the determination of ejection fraction and left ventricular volumes. This situation can only be avoided by optimizing the acustic window and the plane of acustic output of the probe.

The video on the left shows a 4-chamber view during an adenosine stress echocardiography with evidence of a dyskinesia mitseptal and a reduced perfusion signal in this area. In the video on the right, the recording of the same patient during rest shows no wall motion abnormality. The papillary muscle produces a dorsal “shadowing”. The left atrial appendage is not well delineated during systole, compared to the video on the left.


The video shows a 4 – and 3-chamber view. In the top line are displayed the non-contrast-enhanced images, looking like “guess-grams”. The bottom row shows the contrast enhanced loops with a signal loss distal of the posterolateral papillary muscle.