CASE REPORT Year : 2022  |  Volume : 32  |  Issue : 4  |  Page : 221

Large serpiginous thrombus crossing a patent foramen ovale

Davide Ermacora, Patrick Engl, Priscilla Milewski, Simona Casablanca, Roberto Cemin
Department of Cardiology, Bolzano Hospital, Bolzano, Italy

Date of Submission07-Jun-2022Date of Acceptance12-Jul-2022Date of Web Publication23-Jan-2023

Correspondence Address:
Davide Ermacora
Department of Cardiology, Bolzano Hospital, Via Lorenz Bohler 5, 39100, Bolzano
Italy

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jcecho.jcecho_37_22

Transesophageal iconic image of a large serpiginous thrombus crossing a patent foramen ovale.

Keywords: Crossing, echocardiography, patent foramen ovale, thrombus, transesophageal

How to cite this article:
Ermacora D, Engl P, Milewski P, Casablanca S, Cemin R. Large serpiginous thrombus crossing a patent foramen ovale. J Cardiovasc Echography 2022;32:221
How to cite this URL:
Ermacora D, Engl P, Milewski P, Casablanca S, Cemin R. Large serpiginous thrombus crossing a patent foramen ovale. J Cardiovasc Echography [serial online] 2022 [cited 2023 Jan 24];32:221. Available from: https://www.jcecho.org/text.asp?2022/32/4/221/368431

An 87-year-old woman was admitted to our hospital because of acute renal failure, associated with heart failure and atrial fibrillation (AF). AF was very badly tolerated, and therefore, urgent electrical cardioversion (CV) was arranged. Considering the unknown AF duration, to rule out intra-atrial clots, a transesophageal echocardiogram (TOE) was performed before proceeding to CV. The TOE excluded the presence of clots in the left atrium and the left atrial appendage but showed a large thrombus straddling the fossa ovalis. The images, acquired with an off-axis mid-esophageal section at 70°, clearly demonstrated a large serpiginous thrombus (length 50 mm, maximal thickness 9 mm) wedging through a patent foramen ovale [[Figure 1] and Video 1]. Venous ultrasound of the lower limbs also revealed the presence of a left common femoral vein thrombosis. The patient was immediately treated with anticoagulant therapy and CV was delayed. Two weeks after, a TOE was repeated and showed the complete disappearance of the thrombotic formation. The echocardiographic finding of a leaking thrombus through a patent foramen ovale is very unusual, despite the high incidence of this anatomic variant in the healthy population. The diagnosis of paradoxical embolism is usually based on pure speculation, after having excluded other possible causes. In this case, we are able to show directly the event through a single iconic image.

Figure 1: Mid-esophageal section at 70° showing a large serpiginous thrombus wedging through the patent foramen ovale

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given her consent for images and other clinical information to be reported in the journal. The guardian understands that her names and initials will not be published and due efforts will be made to conceal the patient's identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

  [Figure 1]