The proper characterization of intracardiac masses continues to be one of the most relevant challenges in contemporary cardiovascular imaging. Thrombi, benign tumors, and malignant neoplasms share some similar morphological characteristics in conventional echocardiography, but they entail radically different approaches, prognoses, and therapeutic urgencies. Despite significant advances in cardiovascular imaging diagnostic techniques, critical decisions, such as whether to anticoagulate or operate, investigate or observe, treat urgently or monitor, are still frequently challenging in clinical practice. Echocardiography, although indispensable as an initial method, often fails to differentiate thrombi, benign tumors, and malignant neoplasms in a significant number of patients. Given this scenario, it is legitimate to question: why does echocardiography with ultrasound enhancing agents (UEAs), available for decades, still play a secondary role in many diagnostic algorithms?

The meta-analysis, “Diagnostic performance of contrast-enhanced echocardiography in differentiating cardiac masses”, presents important arguments for this context. Using methodological rigor, aligned with PRISMA-DTA and Cochrane Handbook recommendations,^, the authors demonstrate that echocardiography with UEAs has shown exceptional diagnostic performance in two of the most critical dilemmas in clinical practice: differentiating tumors from thrombi and distinguishing benign from malignant tumors.

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