Witnessed embolization of a right atrial mass during transesophageal echocardiography - Implications regarding the safety of esophageal intubation

A patient with chronic lung disease and a right atn al density that was dif ficult to distinguish on a transthoracic echocardiogram underwent transesop hageal echocardiography (TEE) that demonstrated two mobile masses attached to the anterior right atrial wad. During the TEE procedure, the patient exp erienced coughing and retching due to the esophageal intubation, and the em bolization of one of the right atrial masses was observed. This case is the first to document this mechanism of pulmonary embolism (a mechanism that w as suspected in two prior reports), and it questions the safety of procedur es that induce retching and coughing in patients with mobile right atrial m asses.