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Thrombus in transit across a patent foramen ovale in a patient with cerebrovascular accidents, pulmonary embolism, and deep vein thrombosis.

ABSTRACT: The diagnosis of paradoxical emboli remains elusive in many cases. The causal association between the thrombotic source, the intracardiac shunt, and the final emboli location is seldom demonstrated. We present the case of a 42-year-old woman admitted to the hospital with a third stroke. The presence of a thrombus in transit through a patent foramen ovale (PFO), a deep vein thrombosis (DVT), bilateral pulmonary emboli, and an acute cerebral infarct were concurrently documented.

SUBMITTER: Galtes I

PROVIDER: S-EPMC8404599 | biostudies-literature |

REPOSITORIES: biostudies-literature

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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.

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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

Warning regarding thrombosis-in-transit across the patent foramen ovale associated with pulmonary embolism: ultrasonographic imaging analysis.

Project description:Contrast-enhanced CT is useful for diagnosing Pulmonaly embolism (PE) but not for foramen ovale thrombi. Therefore, cardiac ultrasonographic observation of the atrial septum is important to avoid overlooking foramen ovale thrombi.

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Thrombus in Transit within a Patent Foramen Ovale: Gone with the Cough!

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

Thrombus in Transit Entrapped Within a Patent Foramen Ovale: Role of Multimodality Imaging.

Project description: Not available

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Pulmonary embolism and patent foramen ovale thrombosis: the key role of TEE.

Project description:This is a case report of a 35 young man with Klinefelter Syndrome presented breathlessness, palpitations and chest pain. It shows a rare case of a thrombus located through the PFO, in patient with pulmonary and paradoxical embolism, which takes back to exciting hypothesis on thrombus growth. A thrombus, which has grown 'in situ' or trapped through the patent foramen ovale, may be a cause of relapsing pulmonary or systemic embolism during anticoagulation therapy. To prevent recurrent paradoxical embolism, percutaneous closure of PFO is recommended, but in this case, thrombus was trapped through the PFO and the patient was referred to the surgeon. We believe that under these circumstances the clinician should be informed of the presence of PFO in critical pulmonary embolism; this case points out the key role of TEE to face a diagnostic and therapeutic scenarios.

| S-EPMC2020460 | biostudies-other

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

Project description: Not available

| S-EPMC8015975 | 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.

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

Project description: Not available

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Pulmonary embolism with migrating thrombus through patent foramen ovale: A case for a mixed pharmacological and percutaneous management.

Project description:A 61-year-old man, admitted to our hospital for bilateral pulmonary embolism, complicated by right renal ischemia and multiple splenic infarcts due to a mobile thrombus entrapped in a patent foramen ovale, has been successfully treated with apixaban 5 mg twice daily followed by transcatheter patent foramen ovale closure. <Learning objective: Apixaban could be a therapeutic alternative to thrombolysis and surgery in patients with warfarin-resistant thrombus straddling in the patent foramen ovale (PFO). Furthermore, apixaban could be a simple and useful option to manage patients undergoing transcatheter PFO closure. Finally, in the evaluation and treatment of PFO, it is necessary to remember that it is associated not only with cryptogenic stroke but also with non-cerebral, paradoxical systemic embolic events such as myocardial infarction renal, infarct, and limb ischemia.>.

| S-EPMC6342615 | biostudies-literature

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