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

Ju Yeon Oh, Woo Jin Lee, Hak Jin Kim
2018 Korean Journal of Medicine  
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
more » ... ic 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. (Korean J Med 2018;93:61-64)
doi:10.3904/kjm.2018.93.1.61 fatcat:jx6amf2ai5eb3crm3dqmeylrpi