Thrombus-in-Transit Across a Patent Foramen Ovale: Echocardiographic Recognition and Multimodality Management of a Fatal Paradoxical Event.
4 affiliations
- 1Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, USA.
- 2Internal Medicine, New York Medical College/St. Clare's, Denville, USA.
- 3Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA.
- 4Cardiology, New York Medical College/St. Clare's, Denville, USA.
Abstract
Thrombus-in-transit (TIT) across a patent foramen ovale (PFO) is a rare but life-threatening phenomenon that can result in paradoxical systemic embolism. Simultaneous deep venous thrombosis, pulmonary embolism (PE), and an intracardiac shunt create a critical scenario requiring rapid recognition. We report an 83-year-old woman with recurrent venous thromboembolism who presented with progressive dyspnea, pleuritic chest pain, and lower-extremity swelling. Laboratory evaluation revealed leukocytosis of 13.6 ×10⁹/L, thrombocytopenia of 67 ×10⁹/L, creatinine of 1.42 mg/dL, lactate of 2.57 mmol/L, and D-dimer of 32.53 µg/mL. Arterial blood gas analysis showed a pH of 7.47, pCO₂ of 23 mmHg, and pO₂ of 57.8 mmHg. CT pulmonary angiography demonstrated extensive bilateral pulmonary emboli with a left atrial filling defect, while echocardiography revealed a large mobile thrombus crossing a PFO with severe right ventricular dysfunction. The patient underwent emergent pulmonary embolectomy with PFO closure and left atrial appendage ligation but developed refractory cardiogenic shock and multiorgan failure despite venoarterial extracorporeal membrane oxygenation support and died 48 hours later. This case emphasizes the critical role of multimodality imaging in rapidly identifying TIT across a PFO and guiding time-sensitive multidisciplinary management.
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BibTeX
@article{ramalingam2026thrombusintransit,
title = {{Thrombus-in-Transit Across a Patent Foramen Ovale: Echocardiographic Recognition and Multimodality Management of a Fatal Paradoxical Event.}},
author = {Archana Ramalingam and Arshiya Shabnam and Bruno De Souza Goncalves and Aditya Mansabdar and Dhaval Shah},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.116664},
url = {https://europepmc.org/article/MED/42910068},
note = {CC BY},
}
RIS
TY - JOUR
TI - Thrombus-in-Transit Across a Patent Foramen Ovale: Echocardiographic Recognition and Multimodality Management of a Fatal Paradoxical Event.
AU - Archana Ramalingam
AU - Arshiya Shabnam
AU - Bruno De Souza Goncalves
AU - Aditya Mansabdar
AU - Dhaval Shah
PY - 2026
DA - 2026/09/21
JO - Cureus
DO - 10.7759/cureus.116664
UR - https://europepmc.org/article/MED/42910068
AB - Thrombus-in-transit (TIT) across a patent foramen ovale (PFO) is a rare but life-threatening phenomenon that can result in paradoxical systemic embolism. Simultaneous deep venous thrombosis, pulmonary embolism (PE), and an intracardiac shunt create a critical scenario requiring rapid recognition. We report an 83-year-old woman with recurrent venous thromboembolism who presented with progressive dyspnea, pleuritic chest pain, and lower-extremity swelling. Laboratory evaluation revealed leukocytosis of 13.6 ×10⁹/L, thrombocytopenia of 67 ×10⁹/L, creatinine of 1.42 mg/dL, lactate of 2.57 mmol/L, and D-dimer of 32.53 µg/mL. Arterial blood gas analysis showed a pH of 7.47, pCO₂ of 23 mmHg, and pO₂ of 57.8 mmHg. CT pulmonary angiography demonstrated extensive bilateral pulmonary emboli with a left atrial filling defect, while echocardiography revealed a large mobile thrombus crossing a PFO with severe right ventricular dysfunction. The patient underwent emergent pulmonary embolectomy with PFO closure and left atrial appendage ligation but developed refractory cardiogenic shock and multiorgan failure despite venoarterial extracorporeal membrane oxygenation support and died 48 hours later. This case emphasizes the critical role of multimodality imaging in rapidly identifying TIT across a PFO and guiding time-sensitive multidisciplinary management.
SN - 2168-8184
ER -