5 Workup of Noncerebral Systemic Arterial Embolic Source transducer is distant from the left atrium when placed on the chest [52]. In 1 study, a cardiac embolic source was detected by TEE in about 40% of patients with normal TTE [53]. In another study, a cardiac embolic source was identified by TTE in 15% of the study group compared with 57% by TEE [54]. Sensitivity and specificity were 23% and 96%, respectively, for the detection of left ventricular thrombus compared to findings at surgery or pathology [46]. In the detection of left ventricle thrombus, contrast-enhanced TTE had a 64% sensitivity and a 99% specificity compared to a delayed enhancement cardiac MR standard [49]. TTE can also be applied for the diagnosis of valvular disease and cardiac neoplasms. There is no evidence to support the use of TTE in the evaluation of aortic thrombus. Aortography Chest and Abdomen Conventional catheter aortography has largely been replaced by noninvasive imaging modalities such as CTA and MRA given their high sensitivity/specificity for detecting aortic pathologies such as mural thrombus [16,17]. Aortography is typically used as an alternative diagnostic strategy following initial noninvasive imaging and when therapeutic interventions are being considered [11,17]. CT Heart Function and Morphology With IV Contrast The primary role of cardiac CT in the initial evaluation of mesenteric or renal arterial embolic occlusion is in the workup of cardiac thrombus as a source. Multiple studies have established high rates of atrial thrombus detection by cardiac CT compared to TEE [18-27]. Meta-analyses have found sensitivities of 96% to 99% and specificities of 92% to 94% for detection of left atrial or left atrial appendage thrombus with cardiac CT compared to a TEE reference standard [28-30]. When compared to intraoperative findings, cardiac CT was 100% sensitive and 85% specific for finding left atrial thrombus [31].
Workup of Noncerebral Systemic Arterial Embolic Source. 5 Workup of Noncerebral Systemic Arterial Embolic Source transducer is distant from the left atrium when placed on the chest [52]. In 1 study, a cardiac embolic source was detected by TEE in about 40% of patients with normal TTE [53]. In another study, a cardiac embolic source was identified by TTE in 15% of the study group compared with 57% by TEE [54]. Sensitivity and specificity were 23% and 96%, respectively, for the detection of left ventricular thrombus compared to findings at surgery or pathology [46]. In the detection of left ventricle thrombus, contrast-enhanced TTE had a 64% sensitivity and a 99% specificity compared to a delayed enhancement cardiac MR standard [49]. TTE can also be applied for the diagnosis of valvular disease and cardiac neoplasms. There is no evidence to support the use of TTE in the evaluation of aortic thrombus. Aortography Chest and Abdomen Conventional catheter aortography has largely been replaced by noninvasive imaging modalities such as CTA and MRA given their high sensitivity/specificity for detecting aortic pathologies such as mural thrombus [16,17]. Aortography is typically used as an alternative diagnostic strategy following initial noninvasive imaging and when therapeutic interventions are being considered [11,17]. CT Heart Function and Morphology With IV Contrast The primary role of cardiac CT in the initial evaluation of mesenteric or renal arterial embolic occlusion is in the workup of cardiac thrombus as a source. Multiple studies have established high rates of atrial thrombus detection by cardiac CT compared to TEE [18-27]. Meta-analyses have found sensitivities of 96% to 99% and specificities of 92% to 94% for detection of left atrial or left atrial appendage thrombus with cardiac CT compared to a TEE reference standard [28-30]. When compared to intraoperative findings, cardiac CT was 100% sensitive and 85% specific for finding left atrial thrombus [31].