Transesophageal echocardiography (TEE) is a relatively safe imaging modality used to visualize intracardiac thrombus.
We report on a unique, fatal complication during TEE of embolization of a pre-existing "smoking" left atrial thrombus causing acute bilateral internal carotid occlusion, confirmed on angiogram.
Patients with history of lung pathology, such as COPD, who experience retching and cough during transesophageal echocardiography may be more susceptible to embolization of pre-existing thrombi. A need exists to risk stratify such patients.
