title: Thrombus entrapped in a patent foramen ovale, causing only vague symptoms.
abstract: Patent foramen ovale provides a passage from venous circulation to arterial circulation. This may allow passage of a thrombus formed in the venous system into the systemic circulation. We present a case in which a thrombus was entrapped in a patent foramen ovale. A 45-year-old woman presented with complaints of atypical chest pain and pretibial edema. Transthoracic echocardiography showed normal systolic function and grade I diastolic dysfunction. Pulmonary artery pressure was 43 mmHg. There was a mobile multilobular mass in the right atrium, attached to the interatrial septum via a thin pedicle. Transesophageal echocardiography showed a biatrial mass. It was 7-10 mm thick, multilobular, homogeneously echogenic, and highly mobile. It passed through the patent foramen ovale into the left atrium. The left atrial part was 6-8 mm thick, relatively shorter, and less mobile. The patient denied any symptoms related to a cerebrovascular accident. Heparin was initiated and an urgent operation was decided. Intraoperative transesophageal echocardiography showed that the mass was a thrombus which had become smaller due to anticoagulation. She had no neurologic symptoms postoperatively. Venous Doppler examination revealed deep vein thrombosis and warfarin was started.
authors.affiliation: Department of Cardiology, Haydarpaşa Training Hospital, Gülhane Military Medical Academy, Istanbul, Turkey.
authors.forename: Celal
authors.initials: C
authors.lastname: Genç
authors.forename: Mehmet
authors.initials: M
authors.lastname: Uzun
authors.forename: Omer
authors.initials: O
authors.lastname: Yiğiner
authors.forename: Oben
authors.initials: O
authors.lastname: Baysan
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D002637:Chest Pain / Q000209:etiology; D017548:Echocardiography, Transesophageal; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000601:surgery; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin