Thrombus in Transit Entrapped Within a Patent Foramen Ovale: Role of Multimodality Imaging

Figures

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  Figure 1. (A) Chest x-ray, posterior-anterior projection, demonstrates RV enlargement. (B) Twelve-lead electrocardiogram demonstrates sinus tachycardia, right-axis deviation, and diffuse nonspecific T-wave abnormalities.

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  Figure 2. Computed tomography angiography of the chest, PE protocol. (A) Axial image at the level of main pulmonary artery shows multiple filling defects in the pulmonary artery (PA) branches (white arrows). (B) Axial image at the level of the RV demonstrates bilateral filling defects in the pulmonary artery branches (white arrows), TIT attached to the atrial septum (black arrows), and dilated right heart chambers. (C) Axial oblique and (D) sagittal oblique views reveal the TIT (black arrows). LA, Left atrium; RA, right atrium; SVC, superior vena cava.

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  Figure 3. Transthoracic echocardiography. (A) Two-dimensional apical 4-chamber view, diastolic phase, demonstrates a dilated right heart with TIT (∗) best seen in the right atrium (RA) attached to atrial septum. (B) Two-dimensional parasternal long-axis view, systolic phase, demonstrates ventricular septal flattening as a sign of increased RV pressure. (C) Three-dimensional apical 4-chamber view, diastolic phase, demonstrates a dilated right heart with TIT (∗) best seen in the RA attached to the atrial septum. (D) Two-dimensional apical 4-chamber view, systolic phase after agitated saline bubble injection, demonstrates a few bubbles in the left heart side confirming a right-to-left shunt.

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  Figure 4. Two-dimensional TEE, mid and upper esophageal windows. (A) 29° zoomed view demonstrates the TIT (arrows). (B) Bicaval view focused on the PFO demonstrates the TIT (arrows) in both the right and left atrium (RA and LA). (C) Zoomed short-axis display with color flow Doppler demonstrates the TIT (white arrows) and the PFO (black arrow). (D) Upper esophageal window, rightward rotated, 28° view focused on the pulmonary artery (PA), demonstrates a thrombus (red arrows).