Impending paradoxical embolism from atrial thrombus: Correct diagnosis by transesophageal echocardiography and prevention by surgery

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During recovery from a posterolateral myocardial infarction, a 56 year old patient developed signs of deep vein thrombophlebitis and subsequently of pulmonary embolism. After conventional echocardiography showed masses in both atria, transesophageal two-dimensional echocardiography clearly revealed an elongated mass overriding an atrial septal defect. Impending paradoxical embolism was confirmed at surgery.

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From the Division of Cardiology, Department of Internal Medicine, and Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, West Germany.