Fluttering Thrombus in Patent Foramen Ovale With Paradoxical and Cerebral Embolism
A 56-year-old man was admitted with progressive dyspnea that started suddenly the previous day. Physical examination was normal. Pulmonary embolism was diagnosed on a computed tomography scan of the chest, which showed intraluminal filling defects in both pulmonary arteries and in the branches for the right lower lobe; it also showed a clot in the right atrium (Figure 1). Duplex ultrasonography revealed an underlying deep-vein thrombosis of the left popliteal vein.
Transthoracic echocardiography showed a fluttering thrombus trapped in the patent foramen ovale with floating parts in the right and left atrium (Figure 2; see Movies I and II in the online-only Data Supplement). Anticoagulant therapy with unfractionated heparin was started.
During the stay in the hospital, he started to suffer from a headache. The neurological examination was negative. Magnetic resonance imaging was performed, and it showed multiple supraventricular and ventricular hyperintense areas compatible with ischemic lesions (Figure 3). A second echocardiography revealed the dissolution of the thrombus (Figure 4). The patient was discharged in good clinical condition 11 days later and continued to receive anticoagulant therapy.
The online-only Data Supplement is available with this article at http://circ.ahajournals.org/lookup/suppl/doi:10.1161/CIRCULATIONAHA.113.008301/-/DC1.
- © 2014 American Heart Association, Inc.