Thrombus entrapped by patent foramen ovale in a patient with pulmonary embolism: a case report

Abstract

Thrombus-in-transit appears to increase the risk of mortality compared to pulmonary embolism alone and can require alteration in therapeutic plan. We present the case of a biatrial thromboembolus caught in transit across a patent foramen ovale diagnosed by intraoperative transesophageal echocardiogram in a 69-year-old female with acute pulmonary embolism and subsequent acute cerebral infarction. We suggest that echocardiography should be performed in a patient with suspected pulmonary thromboembolism to evaluate right heart function and diagnose emboli in transit.

Keywords: Echocardiography; Patent foramen ovale; Pulmonary embolism.

Fig. 1

Chest CT shows intramural filling defects (arrows) in bilateral pulmonary arteries.

Fig. 2

Transesophageal echocardiography, four-chamber view at the midesophageal level shows the large, mobile, worm-like thrombus (arrows) straddling the PFO in both atria. LA: left atrium, RA: right atrium, PFO: patent foramen ovale.

Fig. 3

Thrombi specimen is removed from (A) right atrium (1.7 × 1.2 × 0.4 cm), inferior vena cava (3.7 × 2 × 1.2 cm), right ventricle (1 × 0.9 × 0.4 cm) and (B) left pulmonary artery, upper lobe (1.8 × 1.3 × 0.7 cm), middle lobe (0.8 × 0.4 × 0.2 cm), and lower lobe (1.5 × 1.4 × 0.4 cm).