Description
“Aquarium sign” was first reported in 2007 in patient with atrio-esophageal fistula who had floating microbubbles in left ventricle by echocardiogram. Since the case with aquarium sign has been rarely reported, the nature has been still unclear.
An 82-year-old male with history of hypertension and type 2 diabetes mellitus was diagnosed with acute myocardial infarction and received percutaneous coronary intervention. On the second hospital day, ventricular fibrillation occurred as a complication of myocardial infarction. He survived owing to percutaneous cardio pulmonary support, however, resulted in renal failure on maintenance dialysis. In a follow-up examination on the 90th hospital day, he complained of an abdominal pain and showed numerous microbubbles in both ventricles which had never been detected by echocardiogram. They showed the similar features of “aquarium sign” which was presented by the previous studies. (Figure) Despite numerous bubbles were presented in both ventricles, he did not show any symptoms of either systemic or pulmonary embolism. Several hours later, he suddenly vomited wine colored blood. Computed tomography revealed diffuse pneumatosis intestinalis and portal venous gas, indicating non-occlusive mesenteric ischemia. He showed rapidly deteriorating conditions and died on the next day in spite of the intensive treatment.
Key Finding(s)
A patient with bowel necrosis showed numerous microbubbles in both ventricles without any symptoms of either systemic or pulmonary embolism.
Differential Diagnosis
Air bubbles, bacterial vegetations, microthrombus.
Implication(s)
The nature of aquarium sign has been unclear. Previous studies has reported that aquarium sign was presented in either right or left ventricle. Therefore, the case with numerous bubbles in both ventricles can be a valuable clue to identify the nature of aquarium sign.

Aquarium sign detected in both ventricles in a patient with bowel necrosis

ECHO ASIA is organized by Asian-Pacific Association of Echocardiography (AAE). The meeting combines the basic echocardiography training curriculum and the state-of-the-art lectures/scientific sessions provided by international as well as Asian-Pacific experts. The meeting is a unique forum where scientists from many countries in the Asian-Pacific region who are involved in the field of Doppler echocardiography gather together to exchange knowledge and skills. Various internationally distinguished faculties consent to present their findings and reveal their clinical experiences in ECHO ASIA.