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Momentarily stuck in the foramen ovale.
Maxime Rousselle1, Pierre-Vladimir Ennezat, Jean-Marc Aubert
1Cardiology Hospital, Boulevard Pr. J. Leclercq, 59000 Lille, France.
Summary
A large thrombus in a patent foramen ovale (PFO) resolved spontaneously without symptoms, despite unsuccessful thromboaspiration. This case highlights unusual PFO thrombus resolution and subsequent melanoma diagnosis.
Area of Science:
- Cardiology
- Vascular Medicine
- Oncology
Background:
- Pulmonary embolism (PE) is a serious condition often caused by blood clots traveling to the lungs.
- Patent Foramen Ovale (PFO) is a common cardiac defect that can allow paradoxical embolism.
- Thromboaspiration is a procedure to remove blood clots.
Observation:
- An 80-year-old woman presented with severe pulmonary embolism.
- A large, serpentine thrombus was identified within a patent foramen ovale.
- The thrombus completely resolved spontaneously without causing any clinical manifestations.
- The thrombus's ultimate destination was the right renal artery.
- Thromboaspiration was attempted but proved unsuccessful.
Findings:
- Spontaneous resolution of a large PFO thrombus is a rare occurrence.
- The absence of symptoms despite a large thrombus suggests potential for asymptomatic embolism.
- The case demonstrates an unusual embolic pathway to the renal artery.
- Three months post-embolism, the patient was diagnosed with malignant melanoma and metastatic disease.
Implications:
- This case underscores the complex and sometimes unpredictable behavior of thrombi in the presence of PFO.
- It highlights the need for considering diverse diagnostic and therapeutic approaches in complex embolic events.
- The co-occurrence with melanoma warrants further investigation into potential links between embolic phenomena and malignancy.
- Further research is needed to understand the mechanisms of spontaneous thrombus resolution in PFO.