Thromboembolism-in-Transit and Patent Foramen Ovale: Should Screening Echocardiogram Be Routine for Thromboembolic Disease?

Background: Thromboembolism-in-transit straddling a patent foramen ovale (PFO) is a rare condition that requires urgent surgical intervention to prevent arterial emboli.

Methods: We present the case of a 42-year-old female who presented with a symptomatic pulmonary embolism. Echocardiography identified a PFO, with a bridging thrombus-in-transit and evidence of right ventricular strain. Urgent surgery was performed because of the risk of systemic embolism. A large thrombus was identified during biatrial exploration. Pulmonary embolectomy and primary PFO closure were performed.

Conclusions: Because of the 20%-30% incidence of PFOs in the general population, we suggest that echocardiography should be considered for routine surveillance in thromboembolism because of the risk of systemic sequelae.