Laparotomy, hx of CVA

47-year-old lady for laparotomy, left hemicolectomy and ileocolic resection



  • Crohn’s disease – current descending colon and terminal ileum strictures
  • Multiple previous surgeries 20 years ago
  • Recurrent perianal abscesses
  • Poorly controlled disease, on 10mg prednisolone and infliximab
  • Cryptogenic occipital CVA in 2019
    • No risk factors
    • Cardiology and neurology review at time of event
    • TTE, and bubble study performed – Reported as normal aside from ‘a probable pseudo-massin LA which could represent a side lobe artefact.’
    • Holter showed Ventricular bigeminy – asymptomatic
    • No further issues with CVA’s


Further investigations warranted?

  • Is there an indication to repeat echo/bubble study?
  • Consensus was no, reported as artifact and a repeat test is unlikely to change management.
  • Suggested that we could discuss this with the cardiologist who reviewed at time


  • Discussed with cardiologist, scans reviewed and happy that LA mass is artefact.
  • Ventricular bigeminy ongoing, cardiologist feels benign in setting of normal LV systolicfunction and lack of symptoms