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A blood clot, or thrombus, is a semi-solid mass composed of fibrin, platelets, and red blood cells. When it forms within a vessel, it can obstruct blood flow, known as thrombosis. If part of the clot detaches, it becomes an embolus that can travel and block distant vessels. When this occurs in the pulmonary arteries, it causes a condition known as pulmonary embolism (PE).Origin and ImpactMost often, the embolus originates from a thrombus in the deep veins of the lower limbs, a condition called...
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Thrombus straddling a patent foramen ovale.

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    A 67-year-old male with pulmonary embolism experienced a mobile thrombus near the patent foramen ovale (PFO). Anticoagulation therapy led to complete thrombus resolution within eleven days.

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    Area of Science:

    • Cardiology
    • Radiology
    • Vascular Medicine

    Background:

    • Pulmonary embolism (PE) is a significant cause of morbidity and mortality.
    • A patent foramen ovale (PFO) is a potential, though uncommon, pathway for paradoxical embolism in PE.
    • Transesophageal echocardiography (TEE) is a valuable tool for visualizing cardiac structures and intracardiac masses.

    Observation:

    • A mobile thrombus was identified straddling the patent foramen ovale (PFO) and prolapsing into both atria in a 67-year-old male presenting with pulmonary embolism.
    • The thrombus was visualized using transesophageal echocardiography (TEE).

    Findings:

    • Initial treatment with heparin was initiated for the pulmonary embolism and associated thrombus.
    • Serial TEE examinations demonstrated a progressive reduction in thrombus size.
    • Complete resolution of the intracardiac thrombus was confirmed by TEE after eleven days of anticoagulation therapy.

    Implications:

    • This case highlights the potential for anticoagulation therapy to effectively resolve large, mobile thrombi associated with pulmonary embolism and PFO.
    • It underscores the utility of serial TEE in monitoring treatment response for such complex embolic events.
    • The findings suggest that a PFO may serve as a nidus for thrombus formation and propagation, emphasizing the importance of comprehensive echocardiographic evaluation in select PE cases.