Warning regarding thrombosis‐in‐transit across the patent foramen ovale associated with pulmonary embolism: ultrasonographic imaging analysis

Abstract

A 55-year-old man (body mass index, 58) was transported to our emergency room for dyspnea. Cardiac ultrasonography (Fig. 1A) was carried out, and a high-intensity mass lying across the foramen ovale was displayed. The edge of the mass was going back and forth between the left ventricle and atrium (Video S1). There was no deep vein thrombosis on contrast-enhanced computed tomography. The patient was diagnosed as having pulmonary embolism and thromboembolism-in-transit across a patent foramen ovale. A massive thrombus was found to be moving to the left atrium, which indicated a very critical state, and open thrombectomy was performed. Transesophageal echography during surgery also displayed a thrombus trapped in the foramen ovale (Fig. 1B), and a giant thrombus, 20 cm long, was removed (Fig. 1C).