Entrapment: thrombus within a patent foramen ovale

A 61-year-old gentleman presented to our institute with increasing dyspnoea. He had a previous diagnosis of a deep vein thrombus and was maintained on coumarin therapy. Investigations to evaluate the cause of his dyspnoea included a chest computed tomography (CT) scan and a bronchoscopy. The CT scan suggested the presence of granulomatous lung disease although subsequent sampling for acid-fast bacilli and sarcoidosis were negative. The patient's health declined and an urgent transthoracic echocardiogram was performed. This demonstrated the presence of a large thrombus lodged within a patent foramen ovale. The patient died shortly later. At postmortem, a large thrombus was confirmed to be straddling across a patent foramen ovale. Lung histology demonstrated that the micronodular opacities visualized on the chest CT scan were in fact pulmonary emboli with fibrosis. We present the echocardiographic appearance of the patent foramen ovale thrombus and its rare pathological correlate at postmortem.