What does this research mean for the field?

A thrombus can become entrapped in a patent foramen ovale, leading to massive pulmonary embolism, which can be effectively treated with heparin and rivaroxaban. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

What question did this study set out to answer?

To present a rare case of thrombus entrapped in a patent foramen ovale leading to a massive pulmonary embolism.

January 17, 2026Open Access

Thrombus entrapped in a patent foramen ovale

Key Result

An 83-year-old female with a massive pulmonary embolism had a thrombus entrapped in a patent foramen ovale, successfully treated with heparin and rivaroxaban.

Key Points

To present a rare case of thrombus entrapped in a patent foramen ovale leading to a massive pulmonary embolism.
Described the case of an 83-year-old female patient admitted with massive pulmonary embolism.
Utilized contrast-enhanced chest CT scan for diagnosis confirmation.
Performed transthoracic and transesophageal echocardiography to identify thrombus.
Diagnosed deep vein thrombosis using duplex ultrasonography.
Administered unfractionated heparin during hospitalization and rivaroxaban after discharge.
Patient presented with chest pain and shortness of breath.
Transthoracic echocardiography showed thrombus in patent foramen ovale and both atria.
Follow-up TTE seven days later showed no clot in the heart.

Structured PICO

Population

n=1, 83-year-old female presenting with chest pain and shortness of breath, diagnosed with massive pulmonary embolism, deep vein thrombosis, and a thrombus entrapped in a patent foramen ovale.

Intervention

Unfractionated heparin during hospitalization followed by rivaroxaban on discharge.

Outcome

Resolution of the cardiac thrombus as assessed by transthoracic echocardiography.surrogate

Medical therapy with unfractionated heparin and rivaroxaban successfully resolved a rare and potentially fatal thrombus entrapped in a patent foramen ovale.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Background. Patent foramen ovales are very common in the population. Thrombus entrapped in a patent foramen ovale is very rare and can cause paradoxical embolism with a high mortality rate. We present the case of a patient diagnosed with a massive pulmonary embolism and a huge thrombus stuck over the interatrial septum. Case presentation. An 83-year-old female patient was admitted to our Coronary care unit with the diagnosis of massive pulmonary embolism confirmed by contrast-enhanced chest CT scan. At admission, the patient complained of chest pain and shortness of breath for the last 24 hours. Transthoracic echocardiography (TTE) showed the presence of a thrombus entrapped in a patent foramen ovale and floating in both atria. Transesophageal echocardiography was done as well to confirm the diagnosis. Deep vein thrombosis was diagnosed by duplex ultrasonography. After discussing the risks and benefits of surgical versus medical treatment, the patient was treated with unfractionated heparin during hospitalization and rivaroxaban on discharge. Seven days later, follow-up TTE showed no clot in the heart. Conclusion. Although rare, the thrombus stuck in patent foramen ovale presents a clinical emergency so early diagnosis and treatment is mandatory.

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