ArticleEuropean heart journal. Case reports2025
From diagnosis to disappearance: a case report on managing atrial septal thrombus with anticoagulation.
Article in European heart journal. Case reports, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The occurrence of atrial septal impending paradoxical embolism in a patent foramen ovale is a rare clinical phenomenon. In a patient with pulmonary artery embolism, transthoracic echocardiography (TTE) revealed a Case summary: A 37-year-old man presented with chest tightness and shortness of breath for 1 week, acutely worsening in the last day before admission. Enhanced computed tomography of the pulmonary artery indicated extensive pulmonary embolism, while TTE showed a large earthworm-shaped mass (∼4.2 cm × 1.4 cm) in the atrial septal fossa ovalis, oscillating slightly with the cardiac cycle. Initially, it was unclear whether the mass was a thrombus or a myxoma. However, after 12 days of anticoagulation, the mass disappeared, suggesting it was a thrombus. The patient underwent percutaneous pulmonary thrombectomy of both arteries, resulting in symptom improvement and stabilized vital signs. Given the patient's young age, such a massive embolic event was unusual. Genetic testing for thrombophilia revealed a Discussion: Pulmonary embolism-induced pulmonary arterial hypertension increased right-to-left shunting through the atrial septal patent foramen ovale, contributing to impending paradoxical embolism development at this site. Thrombophilia might be a key risk factor for this venous thrombotic event.
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