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Extensive biatrial thrombus straddling the patent foramen ovale and traversing into the left and right ventricle
  1. Adil Sattar,
  2. Theingi Tiffany Win,
  3. Alex Schevchuck,
  4. Abinash Achrekar
  1. Department of Internal Medicine, Division of Cardiology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
  1. Correspondence to Dr Adil Sattar, adil.sattar{at}


We report an extremely rare case of an extensive biatrial thrombus straddling a patent foramen ovale (PFO) extending into the bilateral ventricles in a patient presenting with an acute embolic stroke. Our patient further developed a massive saddle pulmonary embolus (PE) with haemodynamic instability during the course of his hospitalisation. The risks of pharmacological thrombolysis or surgical thrombectomy for PE in a haemodynamically unstable patient with recent embolic stroke posed a significant therapeutic dilemma. Ultimately, the decision was made to continue anticoagulation with unfractionated heparin followed by oral Coumadin. The patient responded well to therapy and at 1-month follow-up, a complete resolution of the thrombus was documented on transoesophageal echocardiogram with full clinical recovery of the patient.

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  • Competing interests None declared.

  • Patient consent Obtained.

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