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Management of straddling thrombus through patent foramen ovale complicating pulmonary embolism
  1. Vijeth Bhat1,
  2. Stuart lane2 and
  3. Sam Orde2
  1. 1John Hunter Hostpial, Intensive Care Unit, New Lambton Heights, New South Wales, Australia
  2. 2Intensive Care Unit, Nepean Hospital ICU, Kingswood, New South Wales, Australia
  1. Correspondence to Dr Vijeth Bhat; vijeth.bhat{at}


A 60-year-old man was admitted to intensive care unit with the diagnosis of pulmonary embolism. Bedside transthoracic echocardiography revealed the extension of the thrombus into left atrium and ventricle through patent foramen ovale (PFO). A straddling thrombus also described as impending paradoxical embolism is a rare condition when thrombus embolised to the heart gets caught in PFO. Morbidity is extremely high in case of systemic embolisation. Due to rarity, the treatment options are mainly individualised and no guidelines exist. There are few treatment strategies described in literature from surgical to interventional radiology to conservative approach. Treatment strategy should take individual parameters such as patient’s age, haemodynamic stability, bleeding risk and comorbidities into consideration. Our patient successfully underwent emergency surgical thrombectomy.

  • adult intensive care
  • surgical diagnostic tests
  • radiology (diagnostics)

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  • Contributors SL was clinically involved in treatment of the patient. SO helped with acquisition and reporting of echocardiographic pictures and coordinating patient transfer to another hospital for surgery.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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