title: Mobile thrombi in the abdominal aorta in cases of lower extremity embolic arterial occlusion: value of extended transthoracic echocardiography.
abstract: BACKGROUND
  Lower extremity embolic arterial occlusion is often associated with proximal atherosclerotic and/or aneurysmal disease. Fixed atherosclerotic disease of the abdominal aorta has been demonstrated by ultrasonography, tomographic studies, and aortography, but mobile debris has not previously been described. We report detection of mobile thrombi in the abdominal aorta during transthoracic echocardiography screening in 6 patients with lower extremity embolic arterial occlusion.
  
  
  METHODS
  Six patients were referred to the echocardiography laboratory for evaluation of a source of peripheral arterial embolism. The transthoracic echocardiogram was extended to include longitudinal and transverse images of the abdominal aorta. Additional investigations included abdominal ultrasound (6 patients), computed tomography (2 patients), angiography (2 patients), and transesophageal echocardiography (4 patients).
  
  
  RESULTS
  Six patients (4 men, 2 women, aged 46 to 79 years) presented with a blue toe syndrome consistent with atheroembolism. During transthoracic echocardiography with examination of the abdominal aorta, all were found to have significant atherosclerotic disease of the abdominal aorta with one or more mobile components. This finding had a significant impact on treatment of each patient. Surgical resection of the involved portion of the abdominal aorta in one patient demonstrated an ulcerated atheroma with overlying thrombus.
  
  
  CONCLUSIONS
  In patients with lower extremity embolic arterial occlusion, evaluation of the abdominal aorta during transthoracic echocardiography should be a routine extension of the echocardiographic examination. The finding of mobile thrombi in the abdominal aorta identifies a potential source of embolism for which effective treatment exists.
authors.affiliation: Division of Cardiovascular Medicine and Echocardiography Laboratory and Department of Vascular Surgery, The Mayo Clinic, Rochester, MN 55905, USA. spittell.peter@mayo.edu
authors.forename: P C
authors.initials: PC
authors.lastname: Spittell
authors.forename: J B
authors.initials: JB
authors.lastname: Seward
authors.forename: J W
authors.initials: JW
authors.lastname: Hallett
mesh_terms: D000368:Aged; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging; D001018:Aortic Diseases / Q000000981:diagnostic imaging*; D017548:Echocardiography, Transesophageal; D017700:Embolism, Cholesterol / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography