Thrombus-in-transit and paradoxical embolism

Thromboembolic stroke with concurrent left atrial appendage and left atrial septal pouch thrombus

“…Isolated cases of paradoxical embolism with evidence of an intransit thrombus have been reported. In contrast to the case presented, the thrombus in these cases has been described as dumbbell, or sausage-shaped, straddling the PFO with elongated, mobile extensions into both atria [3,4].A left atrial septal pouch (LASP) is a newly understood anatomical entity with prevalence significantly higher than that of PFO (39% vs. 24%) [5]. It is thought to represent an incomplete closure of the foramen ovale where the fusion line between the septum primum and secundum is limited to the caudal area of the overlapping zone, resulting in a blind recess with no communication into the right atrium.…”

“…Isolated cases of paradoxical embolism with evidence of an intransit thrombus have been reported. In contrast to the case presented, the thrombus in these cases has been described as dumbbell, or sausage-shaped, straddling the PFO with elongated, mobile extensions into both atria [3,4].…”

Echocardiographic diagnosis of a giant thrombus passing through a patent foramen ovale from right atrium to the left atrium

“…There are case reports or case series reported in which intracardiac right-sided thrombus were detected incidentally or during acute PTE [2,3]. The coincidence of PTE and a thrombus entrapped in the patent foramen ovale (PFO) is also reported with in few case reports [4,5]. In these cases generally a paradoxical embolus was also accompanied with the pulmonary embolus.…”

Intraoperative identification of both a paradoxical embolism and its probable etiologic site

“…Paradoxical embolism is uncommon but extremely important clinically. Combining the 4 criteria of Georgopoulos et al [1] and the 4 criteria of Aggarwal et al [2] leave 5 possible criteria for the diagnosis of paradoxical embolism: venous thrombus, a communication between the right and left heart, a right-to-left shunt, a thrombus traversing the communication, and an arterial embolus [1,2]. The fourth criterion is not definitively demonstrated by this case but is assumed because of the confirmatory pathology of the debris removed from the right upper extremity and the CT scans.…”

“…Criteria include the presence of a venous thrombus, a communication between the right and left heart, a right-to-left shunt, a thrombus traversing the communication, and an arterial embolus [1,2]. Transesophageal echocardiography (TEE) is one of several sensitive methods used to assess paradoxical embolism and PFO [3][4][5].…”