Intraoperative transesophageal echocardiographic detection of intracardiac thrombus and pulmonary embolism during orthotopic liver transplant

Transesophageal echocardio-graphy (TEE) utilization during liver transplantation is beginning to gain favor in many medical centers. The intraoperative course during liver transplant includes periods of increased and decreased peripheral vascular resistance, large amounts of third spacing, high volume replacement needs, and the possibility of acute right heart failure and circulatory collapse at reperfusion. Additionally these patients may have underlying systolic dysfunction and coronary artery disease. Intraoperative TEE provides the anesthesiologist with the only single monitoring modality that can be used to diagnose all of these. Fear of bleeding complications due to esophageal varices, and the lack of provider competency with TEE are often sited as reasons to avoid TEE in this patient population. Case Report: This is a case of an intracardiac thrombus and pulmonary embolism in a 44-year-old male undergoing orthotopic liver transplantation for Laennec's cirrhosis. Conclusion: In this case the routine use of intra-operative TEE provided for diagnosis of a massive intracardiac thrombus and pulmonary embolism during the dissection phase of liver transplantation, adding to the growing body of case reports supporting TEE as a diagnostic tool during orthotopic liver transplantation.