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Silent embolism of a large thrombus in transit through the patent foramen ovale: a case report

BACKGROUND : Detection of a thrombus in transit through a patent foramen ovale (PFO) is extremely rare due to the transient nature of the process. We report an unusual case of a large, paradoxical embolus in transit seen on echocardiography through a PFO that was not found upon atriotomy. CASE SUMMA...

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Autores principales: Hegde, Shruti, Kabadi, Mitesh, Johnstone, Michael
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8186917/
https://www.ncbi.nlm.nih.gov/pubmed/34113769
http://dx.doi.org/10.1093/ehjcr/ytab091
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author Hegde, Shruti
Kabadi, Mitesh
Johnstone, Michael
author_facet Hegde, Shruti
Kabadi, Mitesh
Johnstone, Michael
author_sort Hegde, Shruti
collection PubMed
description BACKGROUND : Detection of a thrombus in transit through a patent foramen ovale (PFO) is extremely rare due to the transient nature of the process. We report an unusual case of a large, paradoxical embolus in transit seen on echocardiography through a PFO that was not found upon atriotomy. CASE SUMMARY : An 80-year-old woman presented to the emergency room with shortness of breath and right leg pain. She was haemodynamically stable on presentation, and her physical exam was unremarkable. An ultrasound of her right leg revealed a deep vein thrombus in the posterior tibial vein, and chest computed tomography angiography showed saddle pulmonary emboli. Transthoracic echocardiogram identified a large thrombus in transit through a PFO, which was confirmed with a transoesophageal echocardiogram (TOE). She underwent an emergency embolectomy. The thrombus in transit was confirmed by TOE prior to bypass initiation; however, no thrombi were found in any chambers of the heart following atriotomy. Her postoperative recovery was uneventful. She had no focal neurological deficits or any apparent signs of large vessel embolization. DISCUSSION: Cases of silent embolism have been reported in the literature, although they are rare. To our knowledge, this is the first case of a large thrombus in transit through a PFO in an elderly female that was confirmed by an intra-operative TOE but could not be found following atriotomy, with no obvious clinical signs of embolization.
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spelling pubmed-81869172021-06-09 Silent embolism of a large thrombus in transit through the patent foramen ovale: a case report Hegde, Shruti Kabadi, Mitesh Johnstone, Michael Eur Heart J Case Rep Case Report BACKGROUND : Detection of a thrombus in transit through a patent foramen ovale (PFO) is extremely rare due to the transient nature of the process. We report an unusual case of a large, paradoxical embolus in transit seen on echocardiography through a PFO that was not found upon atriotomy. CASE SUMMARY : An 80-year-old woman presented to the emergency room with shortness of breath and right leg pain. She was haemodynamically stable on presentation, and her physical exam was unremarkable. An ultrasound of her right leg revealed a deep vein thrombus in the posterior tibial vein, and chest computed tomography angiography showed saddle pulmonary emboli. Transthoracic echocardiogram identified a large thrombus in transit through a PFO, which was confirmed with a transoesophageal echocardiogram (TOE). She underwent an emergency embolectomy. The thrombus in transit was confirmed by TOE prior to bypass initiation; however, no thrombi were found in any chambers of the heart following atriotomy. Her postoperative recovery was uneventful. She had no focal neurological deficits or any apparent signs of large vessel embolization. DISCUSSION: Cases of silent embolism have been reported in the literature, although they are rare. To our knowledge, this is the first case of a large thrombus in transit through a PFO in an elderly female that was confirmed by an intra-operative TOE but could not be found following atriotomy, with no obvious clinical signs of embolization. Oxford University Press 2021-03-31 /pmc/articles/PMC8186917/ /pubmed/34113769 http://dx.doi.org/10.1093/ehjcr/ytab091 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Case Report
Hegde, Shruti
Kabadi, Mitesh
Johnstone, Michael
Silent embolism of a large thrombus in transit through the patent foramen ovale: a case report
title Silent embolism of a large thrombus in transit through the patent foramen ovale: a case report
title_full Silent embolism of a large thrombus in transit through the patent foramen ovale: a case report
title_fullStr Silent embolism of a large thrombus in transit through the patent foramen ovale: a case report
title_full_unstemmed Silent embolism of a large thrombus in transit through the patent foramen ovale: a case report
title_short Silent embolism of a large thrombus in transit through the patent foramen ovale: a case report
title_sort silent embolism of a large thrombus in transit through the patent foramen ovale: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8186917/
https://www.ncbi.nlm.nih.gov/pubmed/34113769
http://dx.doi.org/10.1093/ehjcr/ytab091
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