Adult Echocardiography Practice Exam

What type of artifact is created by the calcification of the mitral annulus?

1. Reverberation

2. Attenuation

3. Ring down artifact

4. Comet tail artifact

The correct answer is: Attenuation

The type of artifact created by the calcification of the mitral annulus is best described as attenuation. This artifact occurs when there is an increase in acoustic impedance due to dense structures, such as calcified tissue. When ultrasound waves encounter areas of high attenuation, like calcified regions in the mitral annulus, some of the sound waves are reflected back, while others are absorbed, leading to a reduction in the intensity of the transmitted signal. As a result, the echocardiographic image may show reduced visualization of underlying structures or provide a shadowing effect that is characteristic of higher density tissues. This decreased signal can obscure parts of the heart or misrepresent the morphology of cardiac structures and is a common phenomenon seen in patients with significant calcification, particularly of the mitral valve apparatus or annulus. Other forms of artifact, like reverberation or comet tail artifacts, are caused by different phenomena. Reverberation is produced by multiple reflections of the ultrasound beam between two highly reflective surfaces, while comet tails are a specific type of reverberation artifact resulting from closely spaced reflective interfaces. Ring down artifacts typically arise from gas bubbles or similar structures creating a series of echoes, but they do not specifically relate to the calcification seen in the mitral