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.
Project description:Graphical abstract Highlights • TIT is a thrombus attached to any right heart structure.• Multimodality imaging is essential in patients with TIT to rule out intracardiac shunt.• PFO is the most common access of paradoxical embolization in patients with TIT.
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.
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.
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.
Project description:Background In rare cases of pulmonary embolism, large thrombemboli have been found entrapped in a patent foramen ovale (PFO). Case Description A patient was referred to our center with leg swelling and dyspnea. Electrocardiogram showed sinus tachycardia and right axis deviation. Echocardiography revealed a highly mobile biatrial thrombus entrapped in a PFO extending to both tricuspid and mitral valves and prolapsing into the left ventricle. Urgent surgery for cardiac thrombectomy and PFO closure was performed. Intraoperatively, massive coherent thrombus material was extracted. Conclusion Because of a lack of data, decision making has to rely on clinical judgment rather than evidence.
Project description:Artificial intelligence (AI) is rarely directly used in patent foramen ovale (PFO) diagnosis. In this study, an AI model was developed to detect the presence of PFO automatically in both contrast transthoracic echocardiography (cTTE) images and videos. The whole intelligent diagnosis neural network framework consists of two functional modules of image segmentation (Unet, n = 1866) and image classification (ResNet 101, n = 9152). Finally, another test databases, including 20 cTTE videos (4609 cTTE images), was used to compare the RLS classification model accuracy between AI model and different levels of physicians. The Dice similarity coefficient of left chamber segmentation model of cTTE images was 91.41%, the accuracy of PFO-RLS classification model of cTTE images was 83.55%, the accuracy of PFO-RLS classification model of cTTE videos was 90%. Besides, the AI diagnosis time was significantly shorter than doctors (at only 1.3 s).