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Caught in the act: impending paradoxical embolism.
Alex M Fabricius1, Martin Krüger, Michaela Hanke
1Division of Cardiovascular Surgery, University of Leipzig, Strümpelstrasse 39, D-04289 Leipzig, Germany.
Asian Cardiovascular & Thoracic Annals
|January 23, 2003
Summary
A large clot across a patent foramen ovale resolved spontaneously in a pulmonary embolism patient. This suggests anticoagulation alone may suffice, avoiding invasive procedures.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Pulmonary embolism (PE) necessitates prompt diagnosis and treatment.
- A patent foramen ovale (PFO) can serve as a paradoxical embolism source.
- Transesophageal echocardiography (TEE) is crucial for visualizing cardiac structures and thrombi.
Observation:
- A 73-year-old female presented with pulmonary embolism.
- Initial TEE identified a large thrombus obstructing a PFO.
- Surgical intervention (cardiac embolectomy and PFO closure) was contemplated.
Findings:
- Following systemic anticoagulation, a repeat TEE showed no residual thrombus.
- The PFO remained small, without evidence of the previously observed large clot.
- The patient exhibited no signs of recurrent systemic or pulmonary embolism.
Implications:
- Spontaneous thrombus resolution in PFO associated with PE is possible.
- Systemic anticoagulation may be sufficient treatment, potentially obviating surgery.
- This case highlights the dynamic nature of intracardiac thrombi in PE patients.