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Systemic arterial emboli and cardiac masses. Assessment with transesophageal echocardiography
1Department of Internal Medicine, St. Louis University Medical Center, Missouri.
Insights
Transesophageal echocardiography (TEE) is crucial for detecting cardiac and aortic sources of systemic emboli, such as thrombus and patent foramen ovale. TEE improves diagnosis of cardiac masses and embolic events.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Vascular Medicine
Background:
- Systemic emboli can originate from various cardiac and aortic abnormalities.
- Transesophageal echocardiography (TEE) offers superior sensitivity compared to transthoracic echocardiography (TTE) for detecting these sources.
- Identifying embolic sources is critical for preventing recurrent events.
Purpose of the Study:
- To evaluate the diagnostic utility of TEE in identifying sources of systemic emboli.
- To assess the role of TEE in the work-up of unexplained cerebral ischemia and cardiac masses.
- To highlight the importance of TEE in clinical management decisions.
Main Methods:
- Review of cardiac and aortic findings on TEE implicated in systemic emboli.
- Comparison of abnormality prevalence in patients with and without suspected embolic events.
- Evaluation of TEE's sensitivity for specific cardiac and aortic abnormalities.
- Assessment of TEE's role in diagnosing cardiac tumors.
Main Results:
- Left atrial thrombus, spontaneous contrast, patent foramen ovale, atrial septal aneurysm, and aortic atheroma are significant sources of emboli.
- These abnormalities are more prevalent in patients with embolic events.
- TEE demonstrates higher sensitivity than TTE for detecting these findings.
- TEE can guide management changes for cardiac tumors.
Conclusions:
- TEE is a highly sensitive diagnostic tool for identifying cardiac and aortic sources of systemic emboli.
- Patients with unexplained cerebral ischemia or systemic emboli benefit from TEE evaluation.
- TEE provides critical information for managing patients with suspected cardiac emboli and masses.
Abstract:
Several cardiac and aortic findings on TEE have been implicated as sources for systemic emboli. These findings include left atrial thrombus, left atrial spontaneous contrast, patent foramen ovale, atrial septal aneurysm, and aortic atheroma. The prevalence of each of these abnormalities has been significantly greater in patients with suspected embolic events as compared with controls. Furthermore, the sensitivity of TEE for these findings is much greater than that of TTE. Thus, patients with unexplained cerebral ischemia or systemic emboli should undergo TEE so that possible sources can be detected. In regard to cardiac tumors, although the data are preliminary, certain tumor locations and morphologic aspects are better evaluated with TEE than with other techniques. More importantly, it has been suggested that a change in management of cardiac tumors is initiated by TEE in the majority of instances. TEE provides important diagnostic information in many patients with suspected cardiac emboli and cardiac masses and should be strongly considered in the work-up of such patients.