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Impending paradoxical cerebral embolism in a patient with atrial septal aneurysm

Shinsuke Miyazaki1, Takashi Hirai, Noriyo Hosokawa

  • 1Department of Cardiology, Hokushin General Hospital, Nagano, Japan.

Circulation Journal : Official Journal of the Japanese Circulation Society
|January 27, 2005
PubMed

Insights

A rare thrombus penetrating the atrial septum was visualized, offering insights into stroke mechanisms. This finding highlights the importance of advanced imaging for diagnosing paradoxical embolism.

Area of Science:

  • Cardiology
  • Neurology
  • Medical Imaging

Background:

  • Interatrial septal abnormalities like patent foramen ovale and atrial septal aneurysm are increasingly linked to stroke.
  • Diagnosing the precise mechanism of stroke, particularly those involving cardiac sources, remains challenging.
  • Transseptal thrombi spanning both atria are infrequently detected using standard cardiac imaging.

Observation:

  • A case involving impending paradoxical cerebral embolism is presented.
  • A thrombus was observed to penetrate the atrial septal wall.
  • Transesophageal echocardiography was utilized for visualization.

Findings:

  • Transesophageal echocardiography successfully visualized a transseptal thrombus.
  • The thrombus was located in both the left and right atria, penetrating the interatrial septum.
  • This visualization provided direct evidence of a potential embolic source.

Implications:

  • This case demonstrates the utility of transesophageal echocardiography in diagnosing rare causes of stroke.
  • Accurate identification of transseptal thrombi can refine stroke etiology and guide therapeutic strategies.
  • Further research into the prevalence and clinical significance of such findings is warranted.

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