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Thrombus in transit through a patent foramen ovale: paradoxical embolism

Department of Neurology, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, The Netherlands

Correspondence to:
Correspondence to:
Dr J Raaphorst
Department of Neurology, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, The Netherlands; j.raaphorst@slaz.nl

The first 150 words of the full text of this article appear below.

A 54 year old man presented with right sided arm and leg weakness of sudden onset accompanied by progressive shortness of breath, 3 days after discharge following admission to the intensive care unit (ICU) for treatment of his pneumonia. He complained of a painful right calf. On neurological examination he had a right sided hemiparesis and extensor plantar response. Brain computed tomography showed recent left frontal infarction. A ventilation perfusion lung scan was consistent with multiple pulmonary emboli. Subsequently, ultrasound showed right popliteal vein thrombosis. Two dimensional transoesophageal echocardiography revealed a large thrombus, floating in the right atrium, traversing a patent foramen ovale (PFO) into the left atrium (fig 1). Following thoracotomy, the thrombus was extracted and the patent foramen ovale was closed. The patient recovered with no further symptoms.

View larger version (73K): [in this window] [in a new window]   Figure 1  Image of the heart in the oblique plane (50 degrees), at the level of the aortic root. A large . . . [Full text of this article]