PMC3034930_01
TEE image showing a very large echogenic mass in the right atrium.
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fig1
A transesophageal echocardiography was performed after induction of anesthesia and tracheal intubation, and revealed a large echogenic mass in the right atrium (Figure 1).
(a) TEE image demonstrating the detachment of part of the thrombus (arrow). (b) TEE image demonstrating the detachment of part of the thrombus (arrow).
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fig2
This was possibly due to a detachment of part of the thrombus (Figures 2(a) and 2(b)). The extraction of the echogenic parts towards the left atrium raised the suspicion of an atrial septal aneurysm which was completely filled with thrombi.
TEE recording where the thrombi are not visible.
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fig3
In the following echo recordings, these thrombi were not visible any more (Figure 3).
TEE revealing a huge atrial septal aneurysm with automated contrast after bolus injection of agitated saline in the right jugular vein.
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fig4
A huge atrial septal aneurysm was revealed, after bolus injection of agitated saline in the right jugular vein with automated contrast (Figure 4) and having used provocation manoeuvres including ventilation with PEEP (15 cm H2O) and high tidal volume, a patent foramen ovale was established.