SPONTANEOUS ECHO CONTRAST IN A POLYCYTHEMIC PATIENT WITH A VENTRICULAR SEPTAL-DEFECT

We describe the unusual case of spontaneous echo contrast (SEC) and th rombus occurring in a 23-year-old male with a ventricular septal defec t (VSD), Eisenmenger's complex, and severe polycythemia. The contrast effect was faintly seen by transthoracic echocardiography, and was see n clearly by transesophageal echocardiography. The SEC was present in all four cardiac chambers and was particularly obvious in the left ven tricle (LV). In addition, there was a large thrombus in the LV. The ve locity across the VSD was 1 m/sec. The patient's hematocrit was 74%. T he platelet count was normal and total proteins were 8.9 gm%. The wide spread SEC may be related to rheologic abnormalities related to the se condary polycythemia and, perhaps, became more obvious due to the mode rate LV dysfunction.