Recommendations for the Identification and Mitigation of Cardiac Ultrasound Artifacts: A Guideline from the American Society of Echocardiography

An ultrasound artifact is a feature in an ultrasound image that does not accurately represent the true anatomy or pathology. Cardiac ultrasound artifacts are common and inevitable findings as they originate from the physical properties of ultrasound. Additionally, artifacts may occur due to interference from external equipment and devices producing ultrasound waves. This document provides a uniform and structured approach to managing ultrasound artifacts, including the appearance of the artifact on the image, the mechanism behind the artifact generation, the clinical impact of the artifact on the diagnosis and management of the patient, examples of real cases, and how the artifact can be avoided or mitigated. In addition to true artifacts, we also discuss a series of artifact-like phenomena. Everyone involved in performing or interpreting cardiac ultrasound should be familiar with artifacts and their potential for misdiagnosis, which in some instances may lead to serious clinical consequences. Despite continued improvements in ultrasound imaging technologies, artifacts remain common in all echocardiographic modes, including two-dimensional, spectral, and color Doppler, as well as three-dimensional echocardiography.