Acute Bilateral Internal Carotid Occlusion from Embolization of Left Atrial Thrombus During Transesophageal Echocardiography: Case Report.

BACKGROUND AND PURPOSE:Transesophageal echocardiography (TEE) is a relatively safe imaging modality used to visualize intracardiac thrombus. SUMMARY OF CASE:We report on a unique, fatal complication during TEE of embolization of a pre-existing "smoking" left atrial thrombus causing acute bilateral internal carotid occlusion, confirmed on angiogram. CONCLUSIONS:Patients with history of lung pathology, such as COPD, who experience retching and cough during transesophageal echocardiography may be more susceptible to embolization of pre-existing thrombi. A need exists to risk stratify such patients.