Atrial septal aneurysm and spontaneous echo contrast: an association with higher embolic risk?

We report the transesophageal echocardiogram of a patient who was admitted to the intensive care unit with a diagnosis of acute ischemic stroke, in whom a large atrial septal aneurysm (ASA) was seen bulging toward the right atrium with marked spontaneous echo contrast (SEC) inside but without thrombi, suggesting that ASA and SEC could represent a new association with higher embolic risk.