Embolization of a left atrial ball thrombus during transesophageal echocardiography.

We report a case of systemic embolization of a left atrial ball thrombus during transesophageal echocardiography (TEE). A 49-year-old man with rheumatic mitral stenosis and atrial fibrillation underwent TEE to evaluate a transient cerebral ischemic attack. TEE demonstrated a free-floating left atrial thrombus. Disappearance of the thrombus during the study occurred after tachycardia and was associated with acute hemiplegic stroke and an absent radial pulse. The possible mechanism of embolization and the implications for the selection and management of patients undergoing TEE are discussed.