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Address correspondence to Mamatha Munaf, DM, PDF, Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India. 695011
Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Kerala, India
Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Kerala, India
Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Kerala, India
The presence of artifacts during transesophageal echocardiography (TEE) is well-described. The patient was a 21-year-old woman who had previously undergone tetralogy of Fallot repair as an infant and now presented for pulmonic valve replacement due to severe pulmonic regurgitation. She reported a chronic history of recurrent right pleural effusion that required intermittent drainage. Intraoperative TEE showed a slender, writhing structure lateral to the right atrium, which was attached to it at one point (Fig 1; Video 1). The structure was floating outside the right atrium and showed unique mobility that disappeared after the right pleural cavity was opened. During surgery, the structure was identified as a broken loculated membrane in a pleural effusion. Though TEE detection and quantification of pleural effusion are well-established, the current presentation was highly unusual.
Fig 1Midesophageal 4-chamber view with transesophageal probe rotated towards the right side showing a worm-like structure (red arrow) attached to the right atrium (red star). The pleural effusion is indicated by a red circle.
Video 1. Mid-esophageal 4-chamber view with transesophageal probe rotated towards the right side showing a writhing structure attached to the right atrium.
References
Capper SJ
Ross JJ
Sandström E
et al.
Transoesophageal echocardiography for the detection and quantification of pleural fluid in cardiac surgical patients.
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