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J Med Case Rep

Title:		The first three-dimensional visualization of a thrombus in transit trapped between the leads of a permanent dual-chamber pacemaker: a case report
Author(s):		Maagh P; Butz T; Ziegler A; Meissner A; Prull MW; Trappe HJ;
Address:		"Department of Cardiology and Angiology, Ruhr-University Bochum/Germany, Holkeskampring 40, 45625 Herne, Germany. Petra.Maagh@rub.de"
Journal Title:		J Med Case Rep
Year:		2010
Volume:		20101111
Issue:
Page Number:		359 -
DOI:		10.1186/1752-1947-4-359
ISSN/ISBN:		1752-1947 (Electronic) 1752-1947 (Linking)
Abstract:		"INTRODUCTION: Two-dimensional echocardiography is a useful tool in diagnosing cardiac masses. However, the three-dimensional offline reconstruction technique of transesophageal echocardiography might be superior to two-dimensional transesophageal echocardiography in providing additional information of structural details. CASE PRESENTATION: We report the case of a 76-year-old Caucasian man with a permanent dual-chamber pacemaker and a worm-like right-heart thrombus in transit. Two-dimensional transthoracic echocardiography and two-dimensional transesophageal echocardiography showed that it was debatable as to whether 'the worm' was originating from the leads. Offline three-dimensional transesophageal echocardiography reconstruction technique proved superior in identifying the cardiac mass as a thrombus trapped between the leads of the pacemaker. The thrombus was successfully dissolved by systemic heparin therapy. CONCLUSIONS: The three-dimensional transesophageal echocardiography is useful and effective in patients with implanted pacemakers or defibrillators when other closely competing imaging modalities are contraindicated, such as magnetic resonance imaging. In patients with pacemakers and trapped thrombus in transit for whom surgical therapy might be a high risk, medical therapy seems to offer a safer and convincing alternative. Whether the management of right-heart thrombi has to be modified due to the presence of pacemaker leads is controversial"
Keywords:
Notes:		"PubMed-not-MEDLINEMaagh, Petra Butz, Thomas Ziegler, Andreas Meissner, Axel Prull, Magnus W Trappe, Hans-J eng England 2010/11/13 J Med Case Rep. 2010 Nov 11; 4:359. doi: 10.1186/1752-1947-4-359"