Acute Cardiac Care, December 2014; 16(4): 135 Copyright © 2014 Informa UK, Ltd ISSN 1748-2941 print/ISSN 1748-295X online DOI: 10.3109/17482941.2014.944540

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Thrombus straddling a patent foramen ovale Colin D. Chue, Sohail Qaisar & Jerome Ment Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Birmingham, UK

A 77-year old Caucasian female presented with a 10-day history of progressive breathlessness. Computed tomography imaging of the thorax demonstrated multiple bilateral lobar and segmental arterial pulmonary emboli. Subsequent transthoracic echocardiography demonstrated normal biventricular dimensions and systolic function but a mobile echogenic mass visible in both atria in the apical fourchamber view (Figure 1, arrows; see supplementary data online, video 1 to be found online at http://informahealthcare. com/doi/abs/10.3109/17482941.2014.944540). Further twodimensional transoesophageal echocardiography in the tilted mid-oesophageal four-chamber view (Figure 2, see supplementary data online, video 2 to be found online at

http://informahealthcare.com/doi/abs/10.3109/17482941. 2014.944540) confirmed the appearance of a thrombus straddling a patent foramen ovale (arrow). Surgical excision was advocated but the patient declined. Anticoagulation with warfarin was initiated and the patient was advised to avoid straining. At four-week follow-up, the breathlessness had resolved and repeat transthoracic echocardiography confirmed complete resolution of the thrombus.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Figure 2. This transoesophageal echocardiogram image taken at mid-oesophageal level in the tilted four-chamber view confirmed the presence of a snake-like mass, most likely representing thrombus, straddling a patent foramen ovale (arrow). LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.

Figure 1. Transthoracic echocardiography demonstrated a mobile, echogenic mass (arrows) visible in both atria in the apical fourchamber view. LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.

Supplementary material available online Video 1 and 2 available at http://informahealthcare.com/doi/ abs/10.3109/17482941.2014.944540 Correspondence: Colin D Chue, Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham B9 5SS, UK. E-mail: [email protected] (Received 10 May 2014; accepted 10 July 2014)

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