Transesophageal echocardiography is capable of visualizing rare transseptal thrombi penetrating the atrial septal wall, providing direct evidence for the mechanism of paradoxical embolism.
TEE visualization of rare penetrating transseptal thrombus in one case supports paradoxical embolism mechanism; hypothesis-generating and should not change practice.
There is increasing emphasis on the role of interatrial septal abnormalities, including patent foramen ovale and atrial septal aneurysm, in the genesis of stroke. However, a transseptal thrombus located in both atria is rarely visualized by echocardiography or other cardiac imaging techniques. It is also difficult to prove the mechanism of stroke in most clinical settings. In the present case of impending paradoxical cerebral embolism, the thrombus penetrating the atrial septal wall was visualized by transesophageal echocardiography.
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Miyazaki et al. (2005) studied this question.
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