Entrapment of Pulmonary and Intracardiac Thrombus Through Patent Foramen Ovale: A Case Report

We report a case of a 29-year-old man with no significant medical history presenting with pulmonary embolism (PE). The pulmonary thrombus was extensive and connected to the intracardiac thrombus, which further extended through the patent foramen ovale (PFO) over into the systemic side. We decided to pursue surgical embolectomy, resulting in an excellent outcome for our patient. Other approaches, such as systemic anticoagulation and catheter-directed interventions, were considered but not adopted given the risk of systemic embolization. A bedside echocardiogram before catheter-directed intervention timely guided us to pursue the surgical approach. In considering and discussing current evidence-based approaches, we share the clinical reasoning and special considerations in our approach and decision for choosing a surgical treatment pathway for the management of this patient.