A case of unprovoked, precarious, patent foramen ovale protuberance

This is a case of a precarious thrombotic mass straddling a patent foramen ovale which had already embolised to the pulmonary circulation. The diagnosis was initially deceptive and management challenging. LEARNING POINTS:Echocardiography is mandated and can change management in haemodynamically unstable patients with pulmonary emboli.Pulmonary embolism can be life-threatening.The authors propose that urgent cardiac surgery is the safest treatment in the setting of highly mobile, large volume, intra-cardiac thrombus.