Non Visualization of the Cardiac Structures during Transesophageal Echocardiogram: Think Outside the Heart

摘要

A 73-year-old female with multiple medical conditions, presented with transient bilateral visual loss, which raised the concern for transient ischemic attack. Patient underwent transesophageal echocardiogram (TEE) to rule out cardio-embolic source. Esophageal intubation of TEE probe was performed and adequate oxygen saturation was recorded. No cardiac imaging windows were available in both mid-esophageal and trans-gastric views by TEE. Patient was thought to have either retro cardiac mass or hiatal hernia and the procedure was suspended (Figure 1A). Subsequently, chest X-ray and chest computed tomography (CT) scan (Figure 1B, C, D) showed a large gastric hiatal hernia with nearly the entire stomach in the thorax, without evidence of obstruction. A cardiac CT angiogram was offered as an alternate modality to the patient to rule out cardio embolic source, but patient refused further evaluation.