Pulmonary Embolism, Silent Stroke, and an Occult Caval Thrombus: 1 Clot, 3 Territories.
- 1Department of Intensive Cardiovascular Care and Cardiovascular Imaging, Nhan dan Gia Dinh Hospital, Ho Chi Minh City, Vietnam.
- 2Department of Intensive Cardiovascular Care and Cardiovascular Imaging, Nhan dan Gia Dinh Hospital, Ho Chi Minh City, Vietnam. Electronic address: [email protected].
- 3Department of Cardiac Surgery, Nhan dan Gia Dinh Hospital, Ho Chi Minh City, Vietnam.
Abstract
Background
Clot in transit (CIT) through a patent foramen ovale (PFO) with concomitant pulmonary embolism is a rare condition that carries high mortality and lacks established management guidelines.Case summary
A 67-year-old woman presented with 5 days of exertional dyspnea. Echocardiography showed a mobile thrombus traversing the atrial septum through a PFO with right ventricular dysfunction. Computed tomography pulmonary angiography demonstrated a saddle embolus, and brain imaging revealed a clinically silent paradoxical infarct. Compression ultrasonography showed no deep vein thrombosis. During emergency embolectomy with PFO closure, an unsuspected inferior vena cava thrombus was retrieved.Discussion
CIT requires direct assessment of the pulmonary, systemic arterial, and venous axes before reperfusion is selected; computed tomography pulmonary angiography does not reliably assess the inferior vena cava.Take-home message
When CIT is identified, interrogate the caval axis directly rather than inferring it from a negative pulmonary angiogram.
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BibTeX
@article{le2026pulmonary,
title = {{Pulmonary Embolism, Silent Stroke, and an Occult Caval Thrombus: 1 Clot, 3 Territories.}},
author = {Truong Q Le and Nhat M Giang and Hai H Nguyen and Thanh M Bui},
journal = {JACC. Case reports},
year = {2026},
month = oct,
doi = {10.1016/j.jaccas.2026.110530},
url = {https://europepmc.org/article/MED/42847573},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Pulmonary Embolism, Silent Stroke, and an Occult Caval Thrombus: 1 Clot, 3 Territories.
AU - Truong Q Le
AU - Nhat M Giang
AU - Hai H Nguyen
AU - Thanh M Bui
PY - 2026
DA - 2026/10/01
JO - JACC. Case reports
DO - 10.1016/j.jaccas.2026.110530
UR - https://europepmc.org/article/MED/42847573
AB - Background Clot in transit (CIT) through a patent foramen ovale (PFO) with concomitant pulmonary embolism is a rare condition that carries high mortality and lacks established management guidelines.Case summary A 67-year-old woman presented with 5 days of exertional dyspnea. Echocardiography showed a mobile thrombus traversing the atrial septum through a PFO with right ventricular dysfunction. Computed tomography pulmonary angiography demonstrated a saddle embolus, and brain imaging revealed a clinically silent paradoxical infarct. Compression ultrasonography showed no deep vein thrombosis. During emergency embolectomy with PFO closure, an unsuspected inferior vena cava thrombus was retrieved.Discussion CIT requires direct assessment of the pulmonary, systemic arterial, and venous axes before reperfusion is selected; computed tomography pulmonary angiography does not reliably assess the inferior vena cava.Take-home message When CIT is identified, interrogate the caval axis directly rather than inferring it from a negative pulmonary angiogram.
SN - 2666-0849
ER -