Giant intracardiac thrombus-in-transit in a woman with sudden respiratory-haemodynamic compromise following cesarean section for eclampsia: a case report

Background: Intracardiac thrombus-in-transit is a potentially fatal condition, seldom detected in real time. Case summary: We present a case of a 30-year-old pregnant woman with thalassemia intermedia and asplenia, who experienced a combined respiratory-haemodynamic collapse following an emergent caesarean section performed for eclampsia, and in whom a large mass transversing a patent foramen ovale was observed on bedside echocardiography. In view of the patient's unstable condition, mass' size and location as well as accompanying inter-atrial communication-all of which contributed to an imminent threat to cerebral circulation-and temporal proximity to abdominal surgery and epidural anaesthesia, an immediate open-heart surgery was decided upon that included mass excision and patent foramen ovale closure, and after which the patient quickly and fully recovered. Histopathologic examination of the mass revealed a mixture of thrombotic and amniotic fluid elements. Acute pulmonary embolism was eventually confirmed by computed tomography performed on post-operative day 2. Discussion: Early echocardiography and surgical intervention, as dictated by a multidisciplinary collaboration, allowed for a favourable outcome in our patient, emphasizing their pivotal role in the management of a life-threatening presentation of an intracardiac thrombus-in-transit.