Cardiac MR without contrast is also capable of identifying valvular pathology and cardiac neoplasms, although data on its applicability in the setting of systemic arterial embolism are lacking. US Duplex Doppler Abdomen There is no relevant literature to support the use of Doppler US of the abdomen as an initial imaging modality in the evaluation of the source of known embolic mesenteric/renal arterial occlusion. However, some imaging 7 Workup of Noncerebral Systemic Arterial Embolic Source protocols may include limited views of the abdominal aorta that may detect intraluminal aortic thrombus or significant atherosclerotic disease [56]. US Echocardiography Transesophageal TEE is an invasive diagnostic study with the ability to detect cardiac pathology predisposed to embolism. TEE has a sensitivity of 93% to 100% and a specificity of 95% to 99% for detecting left atrial appendage thrombus when compared to intraoperative findings [31,50,51]. Furthermore, TEE can evaluate left ventricular systolic dysfunction, spontaneous echo contrast, slow left atrial appendage peak flow velocities, and complex left atrial appendage morphologies, which are all associated with left atrial thrombus and thromboembolic risk [2,4]. In addition, TEE can detect left ventricular thrombus, with 1 study reporting a 40% sensitivity and a 96% specificity for the modality compared to findings at surgery or pathology [46]. Proximal aortic thrombus can also be assessed using TEE, although evaluation is limited by blind spots (distal ascending aorta and proximal aortic arch) owing to air in the trachea [10,13]. Detection of valvular disease and intracardiac neoplasms can also be accomplished with TEE. US Echocardiography Transthoracic Resting TTE is a noninvasive imaging modality capable of detecting cardiac pathology susceptible to embolism.
Workup of Noncerebral Systemic Arterial Embolic Source. Cardiac MR without contrast is also capable of identifying valvular pathology and cardiac neoplasms, although data on its applicability in the setting of systemic arterial embolism are lacking. US Duplex Doppler Abdomen There is no relevant literature to support the use of Doppler US of the abdomen as an initial imaging modality in the evaluation of the source of known embolic mesenteric/renal arterial occlusion. However, some imaging 7 Workup of Noncerebral Systemic Arterial Embolic Source protocols may include limited views of the abdominal aorta that may detect intraluminal aortic thrombus or significant atherosclerotic disease [56]. US Echocardiography Transesophageal TEE is an invasive diagnostic study with the ability to detect cardiac pathology predisposed to embolism. TEE has a sensitivity of 93% to 100% and a specificity of 95% to 99% for detecting left atrial appendage thrombus when compared to intraoperative findings [31,50,51]. Furthermore, TEE can evaluate left ventricular systolic dysfunction, spontaneous echo contrast, slow left atrial appendage peak flow velocities, and complex left atrial appendage morphologies, which are all associated with left atrial thrombus and thromboembolic risk [2,4]. In addition, TEE can detect left ventricular thrombus, with 1 study reporting a 40% sensitivity and a 96% specificity for the modality compared to findings at surgery or pathology [46]. Proximal aortic thrombus can also be assessed using TEE, although evaluation is limited by blind spots (distal ascending aorta and proximal aortic arch) owing to air in the trachea [10,13]. Detection of valvular disease and intracardiac neoplasms can also be accomplished with TEE. US Echocardiography Transthoracic Resting TTE is a noninvasive imaging modality capable of detecting cardiac pathology susceptible to embolism.