Pulmonary Embolism With Serpentine Thrombus Straddling a Patent Foramen Ovale

A thrombus straddling patent foramen ovale (PFO) is rare. We present a case of timely diagnosis and surgical management of a life-threatening straddling thrombus in a PFO and pulmonary embolism, utilizing advanced imaging techniques and emergency thrombectomy. We used multimodality imaging (transthoracic echocardiography, transesophageal echocardiography, computed tomography angiography) to confirm and assess a straddling thrombus in the PFO and pulmonary artery, identifying key findings such as a snake-like thrombus crossing the PFO and pulmonary thromboembolism, and performed emergency surgical thrombectomy to remove the thrombus, prevent embolism, and reduce mortality risk. Limited literature describes PFO-straddling thrombus via advanced imaging. Sharing this case highlights timely diagnosis for risk reduction and surgical planning. Straddling thrombi in the PFO are rare but life-threatening, requiring prompt diagnosis and surgical intervention. Advanced imaging is critical for accurate diagnosis and treatment planning. Surgical thrombectomy significantly reduces mortality, emphasizing the need for timely and aggressive management.