Massive Pulmonary Embolism with Thrombus-in-Transit Entrapped by a Patent Foramen Ovale
- Author:
Ju Yeon OH
1
;
Woo Jin LEE
;
Hak Jin KIM
Author Information
- Publication Type:Case Report
- Keywords: Foramen ovale; Patent; Pulmonary embolism; Thrombolytic therapy; Thrombus
- MeSH: 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
- From:Korean Journal of Medicine 2018;93(1):61-64
- CountryRepublic of Korea
- Language:Korean
- 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.
