Atrial-septal-aneurysm-associated thrombus and stroke: Demonstration with transesophageal echocardiography

Atrial septal aneurysm is an increasingly recognized cardiac abnormality. It represents a marked bulging of the interatrial septum into one atrium or the other. A consistent association between this structure and embolic stroke has been demonstrated. Because of the high prevalence of patent foramen ovale or atrial septal defect associated with this structure, paradoxical embolism has been suggested as a mechanism for embolic events. An alternate explanation is the local association of the aneurysm with thrombus. Few data have been found to support this mechanism, however. We report a young woman with multiple strokes during pregnancy in whom transesophageal echocardiography allowed the in vivo demonstration of atrial-septal-aneurysm-associated thrombus. This observation lends further support to the “local thrombus” mechanism of embolie events. It also underscores the potential utility of transesophageal echocardiography in evaluating patients with stroke of uncertain etiology.