title: Ultrasonography in embolic stroke: the complementary role of transthoracic and transesophageal echocardiography in a case of systemic embolism by tumor invasion of the pulmonary veins in a patient with unknown malignancy involving the lung.
abstract: Two-dimensional transthoracic echocardiography is commonly performed to detect a possible cardiac source of systemic embolism and it has been the mainstay of detection and diagnosis of cardiac masses. The transesophageal approach has enhanced the ability to detect cardiac sources of embolism by allowing a better visualization of posterior cardiac structures such as the left atrium with left atrial appendage, pulmonary veins and thoracic aorta and by providing higher resolution images to improve assessment of the presence and extent of cardiac masses. In this case report, echocardiography, using both transthoracic and transesophageal approach, allowed to detect a neoplastic mass arising from the upper left pulmonary vein in a patient presented with a transient ischemic attack. Further investigations showed a malignancy involving the lung. To our knowledge, this is the first reported case in which a cerebral embolic episode represents the clinical onset of a lung cancer, pointing out the importance of echocardiography in all cases of undetermined cerebral ischemic attack.
authors.affiliation: Division of Cardiology, Santa Maria di Loreto Hospital, Naples, Italy. luigi.ascione20@tin.it
authors.forename: Luigi
authors.initials: L
authors.lastname: Ascione
authors.forename: Gianluca
authors.initials: G
authors.lastname: Granata
authors.forename: Maria
authors.initials: M
authors.lastname: Accadia
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Marasco
authors.forename: Roberto
authors.initials: R
authors.lastname: Santangelo
authors.forename: Bernardino
authors.initials: B
authors.lastname: Tuccillo
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology; D004452:Echocardiography; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology; D006338:Heart Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000209:etiology*; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000209:etiology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009360:Neoplastic Cells, Circulating / Q000473:pathology; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000473:pathology; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology*; D014057:Tomography, X-Ray Computed