Project description:Pulmonary embolism and concomitant right atrial thrombus entrapped in a patent foramen ovale (PFO) is a rare, unusual finding in echocardiography. The diagnosis of paradoxical embolism is usually presumptive when PFO is detected by echocardiography. We herein reported a case of a 53-year-old patient presenting with pulmonary embolism in which a thrombusin-transit through a PFO was found and disappeared during transesophageal echocardiography.

| S-EPMC3259544 | biostudies-literature

Diagnosis of large, mobile thrombus in transit within a patent foramen ovale by echocardiography.

Project description: Not available

| S-EPMC8015975 | biostudies-literature

Saddle Pulmonary Embolism with Thrombus in Transit across a Patent Foramen Ovale.

Project description:This is the case of a 25-year-old obese man who presented with acute shortness of breath, chest pain, and palpitations. Of note, he lives a sedentary lifestyle and was recently hospitalized for incision and drainage of a left foot abscess. On presentation he was tachypnoeic, tachycardiac, and hypoxic but blood pressure was stable. Laboratory studies were significant for elevated D-dimer and mildly increased troponin. On further investigation he was found to have a saddle pulmonary embolism with massive clot burden. Echocardiogram revealed thrombus in transit and McConnell's sign. He underwent surgical embolectomy and closure of a patent foramen ovale. This is a particularly rare case, especially in such a young patient. Because this is a rare diagnosis, with insufficient data, there is no formally established treatment guideline. However, in patients who are good surgical candidates, studies have shown better outcome with surgical embolectomy as compared to anticoagulation alone or thrombolysis.

| S-EPMC5299177 | biostudies-literature

Quadri-Chamber Thrombi and Impending Paradoxical Embolism: Thrombus in Transit Through Patent Foramen Ovale.

Project description:Thrombus-in-transit through patent foramen ovale (PFO) is an extremely rare diagnosis that can often be associated with pulmonary embolism. Currently, data exists to guide management options; however, there is no medical consensus with regard to the optimal treatment strategy for thrombus-in-transit through PFO.

| S-EPMC10920151 | biostudies-literature

Swinging serpentine thrombus traversing patent foramen ovale.

Project description: Not available

| S-EPMC2878252 | biostudies-literature

Large Serpiginous Thrombus Crossing a Patent Foramen Ovale.

Project description:Transesophageal iconic image of a large serpiginous thrombus crossing a patent foramen ovale.

| S-EPMC10041399 | biostudies-literature

Thrombus in transit through a patent foramen ovale: catch it if you can-a case report.

Project description:BackgroundPatent foramen ovale (PFO) is one of the most common congenital heart defects, but the finding of a thrombus in transit (TIT) through a PFO is extremely rare. It is a therapeutic challenge, and systemic anticoagulation, cardiac surgery, or fibrinolysis should be considered.Case summaryA 43-year-old woman was admitted with intermediate-high-risk pulmonary embolism. Transthoracic echocardiogram revealed a large right atrial mobile mass that crossed the interatrial septum through a PFO, compatible with TIT, and the patient was started on unfractionated heparin. The diagnosis was confirmed by transoesophageal echocardiogram (TOE). However, during TOE probe removal, the patient developed dyspnoea, sudoresis, and peripheral desaturation, and new image acquisition revealed sudden mass disappearance. Due to the possibility of paradoxical embolization associated with Valsalva manoeuvre, fibrinolysis with alteplase was promptly started. The patient had no signs of embolic or haemorrhagic complications and remained clinically stable. She was discharged on warfarin and then underwent percutaneous transcatheter closure of PFO.DiscussionThe treatment strategy of a TIT through a PFO is controversial, but surgery might be the most appropriate treatment for haemodynamically stable patients, while thrombolysis should be used in cases of haemodynamic instability. Transoesophageal echocardiogram is generally a safe procedure but pressure changes associated with Valsalva manoeuvre may induce embolization of a TIT and attention should be given to patient sedation and tolerance. After complete embolization of a TIT, emergent thrombolysis may be the only treatment option, in order to prevent disastrous consequences related to paradoxical embolism.

| S-EPMC8564690 | biostudies-literature

Silent embolism of a large thrombus in transit through the patent foramen ovale: a case report.

Project description:BackgroundDetection of a thrombus in transit through a patent foramen ovale (PFO) is extremely rare due to the transient nature of the process. We report an unusual case of a large, paradoxical embolus in transit seen on echocardiography through a PFO that was not found upon atriotomy.Case summaryAn 80-year-old woman presented to the emergency room with shortness of breath and right leg pain. She was haemodynamically stable on presentation, and her physical exam was unremarkable. An ultrasound of her right leg revealed a deep vein thrombus in the posterior tibial vein, and chest computed tomography angiography showed saddle pulmonary emboli. Transthoracic echocardiogram identified a large thrombus in transit through a PFO, which was confirmed with a transoesophageal echocardiogram (TOE). She underwent an emergency embolectomy. The thrombus in transit was confirmed by TOE prior to bypass initiation; however, no thrombi were found in any chambers of the heart following atriotomy. Her postoperative recovery was uneventful. She had no focal neurological deficits or any apparent signs of large vessel embolization.DiscussionCases of silent embolism have been reported in the literature, although they are rare. To our knowledge, this is the first case of a large thrombus in transit through a PFO in an elderly female that was confirmed by an intra-operative TOE but could not be found following atriotomy, with no obvious clinical signs of embolization.

| S-EPMC8186917 | biostudies-literature

First direct evidence of a Patent Foramen Ovale (PFO): a large thrombus straddling the foramen ovale.

Project description: Not available

| S-EPMC4771941 | biostudies-literature