A Case of Pulmonary Embolism With a Biatrial Thrombus That Moved Through the Patent Foramen Ovale
小須田 歩1, 高橋 斉1, 谷口 雅1, 下本 睦子1, 福西 雅俊1, 白井 基輝1, 木原 一2, 木原 康隆2, 寺井 浩2, 木原 敏恵2
Ayumi KOSUDA1, Hitoshi TAKAHASHI1, Masa TANIGUCHI1, Mutsuko SHIMOMOTO1, Masatoshi FUKUNISHI1, Motoki SHIRAI1, Hajime KIHARA2, Yasutaka KIHARA2, Hiroshi TERAI2, Toshie KIHARA2
1Clinical Laboratory, Kihara Cardiovascular Clinic, 2Cardiovascular Clinic, Kihara Cardiovascular Clinic
Atrial thrombus, Echocardiography, Patent foramen ovale, Pulmonary embolism
A rare case of pulmonary embolism resulting from a biatrial mobile thrombus that was lodged in the patent foramen ovale is reported here. A 78-year-old man was admitted to this institution complaining of sudden onset of dyspnea. Arterial blood gas analysis showed remarkable hypoxemia. Transthoracic and transesophageal echocardiography showed pulmonary arterial hypertension as well as right atrial and ventricular dilation. A highly mobile snakelike thrombus was readily apparent in the right and left atria. The left atrial thrombus was thought to have come by way of the patent foramen ovale as a result of the right-to-left shunt induced by elevated right atrial pressure and was suspected to have come from a venous thrombiscast. The biatrial thrombus dissolved within 24 hours, probably because of spontaneously activated fibrinolysis. We diagnosed a pulmonary embolism, and the patient was treated vigorously with such anticoagulation agents as intravenous heparin sodium and orally administered warfarin potassium. Therapeutic results were monitored by repeated echocardiographic examination.