Cerebral embolisms caused by a fishbone

A 37-year-old male patient was admitted to the hospital with repeated fever for 15 days and right limb weakness for 7 + hours. Brain magnetic resonance imaging with diffusion-weighted imaging showed multiple high signal intensities in the bilateral cerebral hemisphere, consistent with the performance of cerebral infarction (Panels A and B). Transthoracic echocardiography revealed an ovoid, hypoechoic, mobile mass (19 mm × 17 mm) (green arrow) in the left atrium attached to the root of the anterior leaflet of the mitral valve with no significant valvular abnormalities, and an hyperechoic, immobile mass (24 mm × 26 mm) (red arrow) at the left atrium posterior wall (Panels C and D). Because of its echographic features suggestive of mobile mass, cerebral embolisms originated from the heart were diagnosed. The enhanced chest computed tomography revealed a long strip-shaped high-density shadow pierced the left atrium surrounded by an...