Thrombus-in-transit entrapped in a patent foramen ovale: a complication of brucellosis

Brucella infection may cause vascular complications such as deep venous thromboembolism. This is the first report on an entrapped thrombus in a patent foramen ovale (PFO) in a patient with Brucella infection. A 43-year-old woman was admitted with complaints of fever, dyspnea, malaise, myalgia, and pretibial edema. Clinical and laboratory findings were consistent with brucellosis. Transthoracic echocardiography demonstrated a mobile, hyperechoic worm-like thrombus entrapped in a PFO. Right ventricular enlargement and elevated systolic pulmonary artery pressure (77 mmHg) showed acute pulmonary embolism. Multidetector computed tomography revealed a huge thrombus, 11.7 cm in length, in the bifurcation of the main pulmonary artery. Considering the huge size of the right heart thrombus and hemodynamically significant acute pulmonary embolism, open heart surgery was performed, during which an 11-cm thrombus was found extending from the right atrium across the PFO into the left atrium. The interatrial septum was excised en bloc together with the thrombotic mass and the PFO was closed. Pulmonary thromboendarterectomy was also performed. After surgery, systolic pulmonary artery pressure decreased to 38 mmHg and the patient was discharged without complications.