Right Atrial Thrombus After Aspiration Thrombectomy for Pulmonary Embolism: Oh No or PFO?

A 45-year-old woman with a history of pulmonary embolism, Sjogren syndrome, and hypertension presented with shortness of breath and palpitations.

Computed tomography angiography of the chest showed nonocclusive, bilateral emboli in the main pulmonary arteries and segmental branches. Mechanical thrombectomy was performed, with transthoracic echocardiography revealing a right atrial thrombus within a patent foramen ovale (PFO). Transesophageal echocardiogram confirmed a 2.7 × 0.6 cm thrombus. Aspiration thrombectomy and patent foramen ovale closure with a Sentinel cerebral protection system (Boston Scientific) were performed, without residual thrombus.

Aspiration thrombectomy with patent foramen ovale closure can be beneficial, but it requires embolic protection given the location within the tunnel. Early and aggressive management is critical in preventing serious embolic complications.

Multimodality imaging is essential for effective intervention, especially in patients with high procedural risk. This case underscores the importance of tailored strategies in complex cases involving atypical thrombus presentations.