Transesophageal Ecocardiography: The Correct Intraoperative Way to Detect the Source of Peripheral Embolism in an Emergency

Arterial thromboembolism in patients with an unknown source of embolization is associated with significant morbidity and mortality. Once the acute process has been treated, a search of the offending embolic source must be conducted to prevent additional episodes. The most common sources of peripheral embolism include intracardiac thrombi (>85%), thrombus within arterial aneurysm, thrombus overlying complex atherosclerotic plaques, and paradoxical embolization from deep venous thrombus. A strong association has been shown between protruding, noncalcified plaques >4 cm in the aorta detected by transesophageal echocardiography and the risk of embolism. Moreover, as many as 25-50% of protruding plaques may have superimposed mobile thrombi ranging from one to several centimeters, and this imparts a high embolic risk. The formation of thrombi in morphologically normal aorta is a rare event. We report a case of peripheral embolization in a young man caused by a thrombus in the descending aorta detected by transesophageal echocardiography.