title: Extensive biatrial thrombus straddling the patent foramen ovale and traversing into the left and right ventricle.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Division of Cardiology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.
authors.forename: Adil
authors.initials: A
authors.lastname: Sattar
authors.affiliation: Department of Internal Medicine, Division of Cardiology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.
authors.forename: Theingi Tiffany
authors.initials: TT
authors.lastname: Win
authors.affiliation: Department of Internal Medicine, Division of Cardiology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.
authors.forename: Alex
authors.initials: A
authors.lastname: Schevchuck
authors.affiliation: Department of Internal Medicine, Division of Cardiology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.
authors.forename: Abinash
authors.initials: A
authors.lastname: Achrekar
mesh_terms: D002552:Cerebral Ventricles / Q000473:pathology*; D017548:Echocardiography, Transesophageal; D054092:Foramen Ovale, Patent / Q000473:pathology*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D020767:Intracranial Thrombosis / Q000188:drug therapy / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000473:pathology
chemical_list: D006493:Heparin