Large thrombus-in-transit within a patent foramen ovale in a patient with pulmonary embolism: a case report

J Int Med Res. 2018 Oct;46(10):4332-4337. doi: 10.1177/0300060518789820. Epub 2018 Aug 8.

Abstract

Objective A patent foramen ovale (PFO) is detected frequently by echocardiography. However, a thrombus trapped in a PFO is relatively rare. We herein describe a rare case of a 51-year-old patient with pulmonary embolism in which a large thrombus-in-transit through a PFO was found by echocardiography and disappeared after treatment. Methods A 51-year-old woman presented with a 1-week history of chest tightness, unspecified chest pain, and shortness of breath. Echocardiography revealed a large thrombus trapped in a PFO with increased pulmonary artery pressure, which is a very rare and critical condition. Results The patient was treated with thrombolysis and anticoagulation and discharged from the hospital with an uneventful recovery. Conclusion Our treatment of the present patient achieved a satisfactory result, but it may not be applicable to every patient. Echocardiography is a readily available and safe tool for demonstrating the size, location, and extent of a thrombus, and it plays an important role in the early diagnosis and treatment evaluation for patients with a thrombus trapped in a PFO with concurrent pulmonary embolism.

Keywords: Thrombus-in-transit; anticoagulation; echocardiography; patent foramen ovale; pulmonary artery pressure; pulmonary embolism; thrombolysis.

Publication types

  • Case Reports

MeSH terms

  • Anticoagulants / therapeutic use
  • Computed Tomography Angiography
  • Echocardiography, Transesophageal
  • Female
  • Fibrinolytic Agents / therapeutic use
  • Foramen Ovale, Patent / complications*
  • Foramen Ovale, Patent / diagnostic imaging
  • Humans
  • Middle Aged
  • Pulmonary Embolism / diagnostic imaging
  • Pulmonary Embolism / etiology*
  • Thrombolytic Therapy
  • Thrombosis / complications
  • Thrombosis / diagnostic imaging*
  • Thrombosis / drug therapy
  • Venous Thromboembolism / complications
  • Venous Thromboembolism / diagnostic imaging
  • Venous Thromboembolism / drug therapy

Substances

  • Anticoagulants
  • Fibrinolytic Agents