Early detection of left atrial thrombus in acute cardiogenic cerebral embolism by transesophageal echocardiography.

Re-embolization tends to occur during the first 14 days after the onset of cardiogenic cerebral embolism. The usefulness of early transesophageal echocardiography (TEE) was investigated in 64 patients (33 men and 31 women, mean [+/-SD] age 70.1 +/- 12.6 years) who underwent TEE within 30 days of the onset of cardiogenic cerebral embolism. Patients were retrospectively classified into two groups based on the time from the onset of the embolism to performance of TEE: group A consisted of 33 who underwent TEE within 4 days of the onset and group B consisted of 31 who underwent TEE 5 to 30 days after the onset. Transthoracic echocardiography visualized a left atrial thrombus in two patients, and TEE detected thrombi in 14 patients: 11 in group A and 3 in group B. Lethal re-embolization occurred in two patients in group A who had highly mobile thrombi. Early TEE may be useful for detecting left atrial thrombi and predicting the risk of re-embolization in patients with acute cardiogenic cerebral embolism.