A giant broccoli-like thrombus secondary to patent foramen ovale Patent foramen ovaleye bağlı brokoli benzeri dev bir trombüs A very low pressure gradient between the atria and certain anatomic features of the patent foramen ovale (PFO) may lead to stasis. In addition, a procoagulant environment exists within the PFO tunnel. Owing to these factors, thrombus may occur in the PFO. The 84-year-old female patient presented to our clinic with retrosternal chest pain. She had normal hemodynamic

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... ters. She was urgently transferred to the coronary intensive care unit, considering anterior myocardial infarction upon observing >2 mm ST segment elevation in anterior leads (Fig. 1) . She was transferred to the catheterization laboratory for primary percutaneous coronary intervention (PPCI). After the necessary medical preparations, successful PPCI was performed at the mid portion of left anterior descending artery. The transthoracic echocardiography performed on the 3 rd day of admission, revealed normal size cardiac cavities and hypokinesia of the apical and anterior walls. In addition, a view consistent with a mobile, giant, broccoli-like thrombus originating from the PFO and extending to the left atrium was detected. The follow-up transesophageal echocardiography revealed an image consistent with a thrombus of similar features with a size of 26x16 mm, originating from the PFO (Fig. 2 and Video 1-3. See corresponding video/movie images at www.anakarder. com). Warfarin was added to the current treatment of the patient and the dose was arranged to achieve an INR level between 1.5 and 2.5. In our case, the patient had no history of thromboembolus despite the occurrence of a giant thrombus around the PFO and the cerebral CT performed revealed no results to suggest embolus.