Thrombus-in-transit (TIT) through a patent foramen ovale (PFO) is rare but carries a risk of serious complications, including paradoxical embolism. It is most often associated with pulmonary embolism (PE). We report a case of a 66-year-old male with TIT through a PFO with a massive central PE. The patient was admitted to the Department of Cardiology with symptoms of deep vein thrombosis (DVT) of the lower extremities. The diagnosis was established by Doppler ultrasound of the lower extremities because it was suspected during transthoracic and transesophageal echocardiography. Pulmonary embolism with present TIT is associated with high risk of cardiogenic shock and increased mortality rate. The patient underwent thrombectomy with additional insertion of temporary vena cava filter and was discharged home in stable condition after 34 days of hospitalization. Sequential multidisciplinary cooperation between a cardiologist, cardiac surgeon, and vascular surgeon is the key to managing this critical clinical situation.
Trojanowska et al. (Mon,) studied this question.