SPONTANEOUS ECHO-CONTRAST IN THE LEFT-VEN TRICLE AS AN INDICATOR OF AN INCREASED RISK OF THROMBOEMBOLISM

A 69-year old man with coronary heart disease complained of pain in hi s right flank. He had dyspnoea, cough and fever up to 38,8 degrees C. In addition to various positive indicators of inflammatory disease he had a creatinine concentration of 1.8 mg/dl and an increased activity of lactate dehydrogenase (1655 U/I). The chest radiograph demonstrated pneumonia and computed tomography showed an infarct in the right kidn ey. The ECG indicated atrial fibrillation with an irregular ventricula r rate and left bundle branch block. Echocardiography demonstrated dil atation of the left ventricle and. a thrombus adherent to the wall. Tr ansoesophageal echocardiography additionally recorded spontaneous type I echo-contrast, which disappeared after therapeutic heparinization. Cerebral infarctions were shown by computed tomography, undertaken bec ause of neurological symptoms. There were also signs of silent myocard ial ischaemia. As a coronary artery bypass operation was contraindicat ed, percutaneous transluminal balloon angioplasty was attempted but di ssection occurred, causing irreversible cardiogenic shock of which the patient died.