Continuous Thrombus in the Right and Left Atria Penetrating the Patent Foramen Ovalis
A 34-year-old man with protein S deficiency and deep vein thrombosis was admitted to our hospital because of chest discomfort. Transthoracic echocardiography demonstrated mobile hyperechoic masses in the right and left atria (Figure 1). Contrast-enhanced, ECG-gated, multidetector-16 row CT (Aquilion 16, Toshiba) revealed homogeneous lesions located on the atrial septum in both the right and left atria (Figure 2). Subsequently, ECG-gated, cine cardiac MRI (Intera 1.5 T, Philips) was performed. When viewed as a movie (see online-only Data Supplement), the 2 mobile masses were continuous, suggesting that the thrombus in the right atrium penetrated the left atrium through the patent foramen ovalis (PFO; Figure 3).
Intraoperative transesophageal echocardiography revealed that the mobile masses were consistent with those seen in the cine MRI movie (Figure 4). We surgically resected the masses along with part of the atrial septum and found that the mass developed continuously through the PFO (Figure 5). The magnetic resonance images were considered to result from paradoxical thrombi shifting from the right atrium to the left atrium through the PFO. Histological examination of the mass confirmed an organized thrombus.
The online-only Data Supplement, which contains several movies, is available at http://circ.ahajournals.org/cgi/content/full/112/11/e•••/DC1.