Question
A 67-year-old man with type 2 diabetes mellitus comes to the emergency department because of lightheadedness over the past 2 hours. He reports that he has had similar episodes of lightheadedness and palpitations over the past 3 days. His only medication is metformin. His pulse is 110/min and irregularly irregular. An ECG shows a variable R-R interval and absence of P waves. The patient undergoes transesophageal echocardiography. During the procedure, the tip of the ultrasound probe is angled posteriorly within the esophagus. This view is most helpful for evaluating which of the following conditions?
| A. |
Thrombus in the left pulmonary artery
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| B. |
Myxoma in the left atrium
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| C. |
Aneurysm of the descending aorta
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| D. |
Tumor in the right main bronchus
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Show Answer
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Correct Answer � C
Explanation
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Answer C) Aneurysm of the descending aorta
Aneurysm of the descending aorta
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The upper esophagus lies posterior to the trachea and anterior to the vertebral column. Below the bifurcation of the trachea, the descending aorta lies posterior to the lower esophagus.
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An aneurysm of the descending aorta can, therefore, be visualized well on transesophageal echocardiography (TEE) through an ultrasound probe that is angled posteriorly within the esophagus.
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Other structures lying posterior and in close proximity to the esophagus include the thoracic duct and azygos vein.
Thrombus in the left pulmonary artery
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The esophagus lies posterior to the right pulmonary artery, which can be seen in the anterior view on a TEE.
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However, the left pulmonary artery is hardly visible in any view on TEE.
Myxoma in the left atrium
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A tumor in the left atrium, e.g., left atrial myxoma, can be visualized well on TEE, but only when the probe is rotated anteriorly in the mid-esophagus.
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The left atrium, right atrium, and interatrial septum can be seen in the anterior view.
Tumor in the right main bronchus
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The esophagus lies posterior to the trachea and left mainstem bronchus.
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These structures could be visualized in the anterior view on a TEE, but the right main bronchus would not be seen.
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A chest x-ray or CT imaging of the chest is indicated if a bronchial tumor is suspected.
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