Thrombus entrapped in a patent foramen ovale
Background. Patent foramen ovales are very common in the population. Thrombus entrapped in a patent foramen ovale is very rare and can cause paradoxical embolism with a high mortality rate. We present the case of a patient diagnosed with a massive pulmonary embolism and a huge thrombus stuck over the interatrial septum. Case presentation. An 83-year-old female patient was admitted to our Coronary care unit with the diagnosis of massive pulmonary embolism confirmed by contrast-enhanced chest CT scan. At admission, the patient complained of chest pain and shortness of breath for the last 24 hours. Transthoracic echocardiography (TTE) showed the presence of a thrombus entrapped in a patent foramen ovale and floating in both atria. Transesophageal echocardiography was done as well to confirm the diagnosis. Deep vein thrombosis was diagnosed by duplex ultrasonography. After discussing the risks and benefits of surgical versus medical treatment, the patient was treated with unfractionated heparin during hospitalization and rivaroxaban on discharge. Seven days later, follow-up TTE showed no clot in the heart. Conclusion. Although rare, the thrombus stuck in patent foramen ovale presents a clinical emergency so early diagnosis and treatment is mandatory.