Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2020; 8(20): 4902-4907
Published online Oct 26, 2020. doi: 10.12998/wjcc.v8.i20.4902
Thrombus straddling a patent foramen ovale and pulmonary embolism: A case report
Yi-Xiong Huang, Yu Chen, Yi Cao, Yi-Gang Qiu, Jian-Yong Zheng, Tian-Chang Li
Yi-Xiong Huang, Yu Chen, Yi Cao, Yi-Gang Qiu, Jian-Yong Zheng, Tian-Chang Li, Department of Cardiology, Sixth Medical Center of PLA General Hospital, Beijing 100048, China
Author contributions: Each author has contributed significantly to the submitted work; Huang YX and Cao Y were in charge of this patient; Qiu YG placed inferior vena cava filter for the patient; Huang YX drafted the manuscript; Chen Y and Zheng JY critically revised it for important intellectual content; Li TC, the corresponding author of this manuscript, finally approved the manuscript submitted; All authors have read and approve the final manuscript.
Supported by The Application of Clinical Features of Capital City of Science and Technology Commission China Beijing Special Subject, No. Z151100004015205.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and accompanying images.
Conflict-of-interest statement: Nothing to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Tian-Chang Li, MD, PhD, Chief Physician, Department of Cardiology, Sixth Medical Center of PLA General Hospital, No. 6 Fucheng Road, Beijing 100048, China. ltc909@163.com
Received: April 22, 2020
Peer-review started: April 22, 2020
First decision: August 8, 2020
Revised: August 20, 2020
Accepted: September 10, 2020
Article in press: September 10, 2020
Published online: October 26, 2020
Processing time: 186 Days and 6.5 Hours
Abstract
BACKGROUND

Venous thromboembolism is a common vascular syndrome presenting as deep vein thrombosis and/or pulmonary embolism. Thrombus has the possibility of migrating into the left circulation via patent foramen ovale in certain extreme circumstances. Thrombus straddling a patent foramen ovale is a direct evidence of this scenario. However, the confirmed cases of thrombus in transit are still rare.

CASE SUMMARY

A 32-year-old man suffered from recurrent syncope and intermittent dyspnea for 1 wk. Transthoracic echocardiography confirmed a thrombus straddling the patent foramen ovale, and thrombi were also found in the bilateral pulmonary artery by computed tomography. The man underwent inferior vena cava filter placement and thrombolysis with alteplase. Echocardiography showed the absence of thrombi in both the right atrium and left atrium 2 d after hospitalization. The man was discharged to home on warfarin without any complications 2 wk later.

CONCLUSION

Scrutinizing intracardiac thrombi provides measurable value in pulmonary embolism as closure of patent foramen ovale may be considered in certain patients. Early intervention plays a critical role in thrombus straddling a patent foramen ovale. A sedentary lifestyle may predispose young adults to thromboembolism, even if there are no other risk factors.

Keywords: Thrombus; Patent foramen ovale; Pulmonary embolism; Case report

Core Tip: Thrombus straddling a patent foramen ovale is a life-threatening condition that is usually complicated with pulmonary embolism. We present a rare case of deep venous thrombosis, concomitant with pulmonary embolism and transient ischemic attack. Transthoracic echocardiography revealed a large thrombus straddling the patent foramen ovale. There was no significant predisposing factor for thromboembolism except the sedentary lifestyle of the young patient. This case highlights the crucial role of echocardiography in a patient with pulmonary embolism. Identifying intracardiac thrombi may modify the strategies of thromboembolic disease. Moreover, a vigorous lifestyle should be recommended for avoiding thrombotic disaster among young adults.