Migrating Thrombus Trapped in a Patent Foramen Ovale
A 36-year-old woman with a 3-week history of shortness of breath was admitted to the hospital after having suffered syncope. She also complained of left-sided leg pain. Duplex ultrasound revealed a right-sided proximal deep venous thrombosis and an occluded left popliteal artery. Echocardiography demonstrated a dilated right ventricle and tricuspid regurgitation with an estimated pulmonary systolic pressure of 80 mm Hg. Spiral CT demonstrated multiple central pulmonary emboli; cranial MRI showed multiple small infarcted zones; and transesophageal echocardiography (TEE) revealed a patent foramen ovale. After embolectomy of the left popliteal artery and a 10-day course of anticoagulation, follow-up echocardiography showed a possible thrombus in the right atrium. Therefore, TEE was performed, which revealed a thrombus ≈10 cm long caught in the foramen ovale on its way to the left atrium (Figure 1⇓). At emergent cardiac surgery, the thrombus was extracted (Figure 2⇓), the persistent foramen ovale closed, and a vena cava filter inserted.
- Copyright © 2001 by American Heart Association