Home > Case of the Month > Case 11

Case 11

History

  • 58 year old male
  • CVA

Findings




Diagnosis

Basal inferolateral infarct, Lt. Atrial appendage thrombus and Lt ventricle apical thrombus
  • CVA: Ischemic aetiology (88%)- carotid embolic disease 20%, cardiogenic 20-25%
  • Of the cardiogenic: 50% lt atrial thrombus secondary to atrial fibrillation. 50%: LV thrombus, paradoxical emboli (PFO), valvular disorders (native and artificial),subacute bacterial endocarditis, cardiac tumours
  • Traditional work-up: Doppler U/S of neck. If negative : Transthoracic echocardiography (TTE)
  • Poor acoustic window especially if COPD, obese or breast implants
  • TTE Not good for evaluating for atrial thrombus/ Aortic plaque
  • Trans esophageal echocardiography (TEE)
  • Operator dependent, semi-invasive, conscious sedation. Need physician, nurse +/- technologist. Post procedure monitoring
  • Minor trauma, non-fatal arrythmias
  • Major complicaions: esophageal/gastric perforation rare- 0.02%
  • MRI: non-invasive widely available . Possible to evaluate brain major arteries and heart in one exam
  • More studies comparing TEE and MRI for sensitivity and cost need to be done

Treatment

  • Anticoagulation