Systemic arterial emboli and cardiac masses. Assessment with transesophageal echocardiography.

Several cardiac and aortic findings on TEE have been implicated as sources for systemic emboli. These findings include left atrial thrombus, left atrial spontaneous contrast, patent foramen ovale, atrial septal aneurysm, and aortic atheroma. The prevalence of each of these abnormalities has been significantly greater in patients with suspected embolic events as compared with controls. Furthermore, the sensitivity of TEE for these findings is much greater than that of TTE. Thus, patients with unexplained cerebral ischemia or systemic emboli should undergo TEE so that possible sources can be detected. In regard to cardiac tumors, although the data are preliminary, certain tumor locations and morphologic aspects are better evaluated with TEE than with other techniques. More importantly, it has been suggested that a change in management of cardiac tumors is initiated by TEE in the majority of instances. TEE provides important diagnostic information in many patients with suspected cardiac emboli and cardiac masses and should be strongly considered in the work-up of such patients.