Spontaneous echocardiographic contrast (SEC), also known as “echocardiographic smoke” is an echogenic swirling pattern of blood flow created by enhanced ultrasonic back-scatter from clumping of the cellular components of blood in instances of stagnating or low-velocity (low-flow states) 1. It differs from random speckle of white noise artifacts or the discrete bright reflectors produced by injected microbubbles, from microbubbles related to cavitation from prosthetic valves and from transient contrast echoes from the pulmonary veins into the left atrium following a cough or the Valsalva maneuver 2,3.
Blood stasis is thought to be the cause of smoke-like SEC which may be seen within the cardiac chambers or vessels. It is associated with an increased risk of thrombus development and stroke thromboembolism. The activation of the clotting system has no effect on this phenomenon 3,4.
Patients who have aortic aneurysm or dissection, left ventricular dysfunction, dilated left atrium, mitral stenosis, reduced cardiac index, constant atrial fibrillation and heart failure are more likely to have it 3.
Although the occurrence of SEC is commonly attributed to erythrocyte rouleaux formation in sluggish blood flow, a number of different hemorheological correlates of SEC have been reported. These include the presence of anticardiolipin antibody, an increased erythrocyte sedimentation rate (ESR), and increased plasma fibrinogen and viscosity levels 5.
Transesophageal echocardiography (TEE), a strong technique for both the identification and follow-up of SEC.
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