Korean J Med.  2018 Feb;93(1):61-64. 10.3904/kjm.2018.93.1.61.

Massive Pulmonary Embolism with Thrombus-in-Transit Entrapped by a Patent Foramen Ovale

• Oh JY
• Lee WJ
• Kim HJ

• KMID: 2435037
• DOI: http://doi.org/10.3904/kjm.2018.93.1.61

Abstract

"Thrombus-in-transit" in pulmonary embolism is associated with high mortality and refers to a free-floating clot in the right atrium or right ventricle, indicating that deep vein thrombosis is present en route to the pulmonary artery. Thrombus entrapped in a patent foramen ovale (PFO) is a rare condition and is associated with paradoxical systemic embolism. Here, we report a case of acute pulmonary embolism with thrombus-in-transit through a PFO in a 68-year-old woman with a diagnosis of metastatic pancreatic cancer undergoing palliative chemotherapy. She presented with syncope after acute onset of exertional dyspnea and was diagnosed with cardiogenic shock due to massive pulmonary embolism with thrombus-in-transit on admission to the emergency room. We treated her with systemic thrombolysis and anticoagulation therapy instead of surgical thrombectomy. We show that hemodynamically unstable pulmonary embolism with thrombus-in-transit entrapped by a PFO may be successfully treated with systemic thrombolysis without paradoxical embolism.

Keyword

Foramen ovale; Patent; Pulmonary embolism; Thrombolytic therapy; Thrombus

MeSH Terms

Aged
Diagnosis
Drug Therapy
Dyspnea
Embolism
Embolism, Paradoxical
Emergency Service, Hospital
Female
Foramen Ovale
Foramen Ovale, Patent*
Heart Atria
Heart Ventricles
Humans
Mortality
Pancreatic Neoplasms
Pulmonary Artery
Pulmonary Embolism*
Shock, Cardiogenic
Syncope
Thrombectomy
Thrombolytic Therapy
Thrombosis
Venous Thrombosis