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Cinefluoroscopy appears to be more sensitive than CXR for the detection of Riata cable extrusion. Interpretation of CXR by a radiologist with education in lead defects correlates highly with cinefluoroscopy with very high specificity. Depending on available resources for screening, CXR may be a reasonable alternative to cinefluoroscopy. Multidisciplinary collaboration across specialties (radiology and electrophysiology) can lead to improved diagnostic capability and thus the potential for enhanced quality of care.

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A 60-year-old woman presented with fever and shortness of breath of one week's duration. Physical examination disclosed a right-lower-quadrant abdominal mass and pretibial edema. A chest computed tomogram showed bilateral pulmonary embolism, and venous Doppler ultrasonographic imaging of the lower extremities revealed acute deep vein thrombosis (DVT) of the right common femoral vein. Abdominal ultrasonograms showed a large right ovarian mass. A 2-dimensional transthoracic echocardiogram (2D TTE) showed an echogenic mass in the atria. Two-dimensional transesophageal echocardiograms (TEE) revealed an aneurysmal interatrial septum and a large, mobile mass in the right atrium. The mass was in transit through a patent foramen ovale and extended into the left atrium ( Fig. 1). Three-dimensional (3D) TEE helped to characterize the mass as a thrombus-intransit that extended through the interatrial septum (Fig. 2). Upon sequential cropping of the images, echolucent components seen inside the mass were consistent with an intracardiac thrombus.1 The ovarian mass was found to be malignant. The patient was prescribed long-term anticoagulation. After 6 months, 2D TTE revealed complete resolution of the thrombus and no evidence of left-sided emboli. CommentThrombus-in-transit is rarely reported and is often associated with pulmonary embolism or paradoxical systemic embolism when an intracardiac shunt is present. In our patient, DVT associated with a hypercoagulable state of malignancy was thought to be responsible for the thrombus-in-transit and the pulmonary emboli.Thrombi-in-transit have almost exclusively been diagnosed with the use of echocardiography.2 Using 3D TEE enables the sequential sectioning of an intracardiac mass and inspection of its inner aspects from multiple angles. This in turn helps to establish a more accurate diagnosis and more specific therapeutic interventions. The most appropriate therapy for thrombus-in-transit has not been clearly defined; antico- Figure 1B. Images in Cardiovascular Medicine

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