What question did this study set out to answer?

This case aims to demonstrate the risks associated with thrombus-in-transit through a patent foramen ovale in patients with pulmonary embolism.

May 15, 2026Open Access

Five minutes to twelve: thrombus-in-transit (TIT) through a patent foramen ovale (PFO) in a patient with massive central pulmonary embolism — an example of a multidisciplinary cardiovascular therapeutic challenge

Key Points

This case aims to demonstrate the risks associated with thrombus-in-transit through a patent foramen ovale in patients with pulmonary embolism.
A 66-year-old male diagnosed with massive central pulmonary embolism and deep vein thrombosis.
Diagnosis established using Doppler ultrasound and echocardiography.
Patient underwent thrombectomy and underwent placement of a temporary vena cava filter.
Patient was discharged in stable condition after 34 days of hospitalization.
Thrombus-in-transit through a patent foramen ovale was associated with high cardiogenic shock risk.
The need for multidisciplinary cooperation was essential for managing the critical situation.

Abstract

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.

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