Author + information
- Received September 25, 2008
- Revision received December 12, 2008
- Accepted December 18, 2008
- Published online April 14, 2009.
- Vernon Mascarenhas, MD*,
- Arun Kalyanasundaram, MD, MPH*,
- Louis Andrew Nassef, MD*,
- Serrie Lico, MD† and
- Anwer Qureshi, MD*
A 66-year-old obese woman presented with shortness of breath over 8 weeks. She was hemodynamically stable. D-dimer was elevated at 2.14. Transthoracic (Online Video 1) followed by transesophageal echocardiogram (TEE) showed a mass extending from the inferior vena cava into the tricuspid valve and also across the foramen ovale (PFO) via the left atrium (A, Online Videos 1, 2, and 3) into the ventricle. Emergent surgery confirmed embolus trapped in the foramen ovale (B and C)and bilateral massive pulmonary emboli. She was anticoagulated subsequently and discharged home. Identification of a thrombus “caught in the act” across the PFO is a rare occurrence. This in conjunction with a pulmonary embolism has been reported only once before in published literature. Prompt recognition of the “mass” on transthoracic echocardiogram and further characterization on TEE to assess the extent of the thrombus led to emergent surgery and was life-saving.
- Received September 25, 2008.
- Revision received December 12, 2008.
- Accepted December 18, 2008.
- American College of Cardiology Foundation