Pulmonary embolism and thrombus in transit through patent foramen ovale

Abstract Thrombus-in-transit through a patent foramen ovale (PFO) in a patient with pulmonary embolism (PE) is a rare event with high mortality rates. We report the case of 53-year-old woman admitted for dyspnoea, cough, haemoptysis, pre-syncope, tachycardia and hypotension. A recent fall down the stairs with costal trauma was also reported. At transthoracic echocardiography, dilated right atrium with the presence of a large floating thrombus was found, protruding into the left atrium through a PFO; lower extremity vascular ultrasound showed right great saphenous vein thrombosis extended over the sapheno-femoral junction up to the common femoral vein. CT scan showed a sub-massive thrombo-embolism; surgical thrombectomy was therefore performed with closure of the PFO; an inferior vena cava filter was also positioned for the prevention of recurrent episodes of thromboembolism. The patient was discharged in therapy with apixaban 5 mg twice a day. Two-month follow up was uneventful. Large thrombi in transit through PFO can be found at trans-thoracic echocardiography. The management, either medical or surgical, should be aimed at preventing systemic thrombo-embolism.