title: Thrombus-in-transit and paradoxical embolism.
abstract: Paradoxical embolism is an uncommon but clinically important phenomenon. Elements of diagnosis include the presence of: (1) a venous thrombus, (2) an arterial embolus, (3) a communication between the right and left heart, and (4) a thrombus traversing such a communication. Unfortunately, all of these elements can be rarely demonstrated in each case but the probability should be considered in any patient with 2 or more present. It should be suspected in patients who have evidence of systemic arterial emboli without apparent cause. A transesophageal echocardiogram with contrast should be considered in cases where paradoxical embolism is a possibility. We present a case in which a "thrombus-in-transit" was imaged across the interatrial septum in a patient with a patent foramen ovale, deep venous thrombosis, and an embolic cerebrovascular stroke.
authors.affiliation: University Hospital and Clinics, MC 312 Cardiology, University of Missouri Health Sciences Center, One Hospital Drive, Columbia, MO 65212, USA. aggarwalk@health.missouri.edu
authors.forename: Kul
authors.initials: K
authors.lastname: Aggarwal
authors.forename: Vinod K
authors.initials: VK
authors.lastname: Jayam
authors.forename: Michael A
authors.initials: MA
authors.lastname: Meyer
authors.forename: Atasu K
authors.initials: AK
authors.lastname: Nayak
authors.forename: Sriram
authors.initials: S
authors.lastname: Nathan
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D017548:Echocardiography, Transesophageal; D019320:Embolism, Paradoxical / Q000000981:diagnostic imaging* / Q000601:surgery; D006325:Heart Atria; D006344:Heart Septal Defects, Atrial / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male