Evaluation of Cardiac Sources of Emboli by Echocardiography

  • Azin Alizadehasl
  • Anita Sadeghpour


An embolus is an intra-vascular mass that generally includes a thrombus and atheromatous or cellular matter that has entered the circulation and creates symptoms by lodging at the end of the arteries and disturbing the blood flow to the organs. Emboli from the venous system might enter the right side of the heart and cause pulmonary emboli, while those created on the left side of the heart and great arteries may create infarcts in the brain, kidneys, intestine, and skin. Though, small strokes and transient ischemic attacks are frequently caused by atheromatous debris from the aorta or major cerebral arteries. A paradoxical embolus is a systemic infarct in which the source of the embolus is supposed to be from the venous system; it bypasses the pulmonary circulation by means of an intra-cardiac shunt and goes across into the arterial circulation.


Sources of emboli Deep venous thrombosis (DVT) Embolic strokes Lambl’s excrescences Patent foramen ovale (PFO) Intra-cardiac thrombus Atrial fibrillation Thromboembolism 



Atrial septal aneurysm


American society of echocardiography


Aortic valves




Deep venous thrombosis


Inter-atrial septum


Left atrial


Left atrial appendage


Magnetic resonance


Mitral valve


Patent foramen ovale


Right atrium


Right ventricle


Transesophageal echocardiography


Transthoracic echocardiography

Supplementary material

Movie 37.1

Trans-esophageal echocardiography, long axis view showing complex atherosclerotic plaque in descending thoracic aorta (AVI 12102 kb)

Movie 37.2

Trans-esophageal echocardiography showing large fresh left atrial appendage clot associated with spontaneous contrast in LA (MP4 3093 kb)

Movie 37.3

Off axis 4 chamber view showing dyskinetic apico-septal segment with apical thrombus (AVI 11625 kb)

Movie 37.4

Off axis 4 chamber view showing dyskinetic apico-septal segment with apical thrombus (AVI 12860 kb)

Movie 37.5

Vegetation on mitral bio-prostheses visualized in TEE (AVI 7408 kb)

Movie 37.6

Trans-esophageal echocardiography, mid esophageal 130′ view showing lambl’s excrescence of aortic valve that can be a source of emboli (AVI 9161 kb)

Movie 37.7

Transesophageal echocardiography, mid esophageal 0′ view showing thrombus in transit via patent foramen ovale (AVI 9134 kb)

Movie 37.8

Transesophageal echocardiography, mid esophageal 97′ view showing large patent foramen ovale with some bubble passage in contrast study (AVI 13268 kb)

Movie 37.9

Transesophageal echocardiography, mid esophageal 120′ modified bicaval view showing inter-atrial septum aneurysm (AVI 4884 kb)

Movie 37.10

Transesophageal echocardiography, mid esophageal 80′ bicaval view showing inter-atrial septum aneurysm with significant smoke pattern (AVI 30233 kb)


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Azin Alizadehasl
    • 1
  • Anita Sadeghpour
    • 2
  1. 1.Associate Professor of Cardiology, Echocardiologist, Echocardiography and Cardiogenetic Research CentersCardio-Oncology Department, Rajaie Cardiovascular Medical and Research CenterTehranIran
  2. 2.Professor of CardiologyEchocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical ScienceTehranIran

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