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(Chest. 1999;115:1462-1464.)
© 1999 American College of Chest Physicians

Witnessed Embolization of a Right Atrial Mass During Transesophageal Echocardiography*

Implications Regarding the Safety of Esophageal Intubation

Kevin D. Kwak, MD; Steven F. Mosher, MD; Casey L. Willis, RDCS and Bruce J. Kimura, MD

* From the Departments of Cardiology (Dr. Kimura and Ms. Willis) and Internal Medicine (Drs. Kwak and Mosher), Scripps-Mercy Hospital, San Diego, CA.

Correspondence to: Bruce J. Kimura, MD, Scripps-Mercy Noninvasive Cardiology, 230 Prospect Place No. 250, Coronado, CA 92118

A patient with chronic lung disease and a right atrial density that was difficult to distinguish on a transthoracic echocardiogram underwent transesophageal echocardiography (TEE) that demonstrated two mobile masses attached to the anterior right atrial wall. During the TEE procedure, the patient experienced coughing and retching due to the esophageal intubation, and the embolization of one of the right atrial masses was observed. This case is the first to document this mechanism of pulmonary embolism (a mechanism that was suspected in two prior reports), and it questions the safety of procedures that induce retching and coughing in patients with mobile right atrial masses.

Key Words: esophagus • heart atrium • gastrointestinal intubation • pulmonary embolism • transesophageal echocardiography






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Copyright © 1999 by the American College of Chest Physicians.