Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2013;66:995 - Vol. 66 Num.12 DOI: 10.1016/j.rec.2012.02.023

Unusual Case of Huge In-transit Thrombus: a Challenge for Three-dimensional Echocardiography

Oscar Salvador Montañés a,, Teresa López Fernández a, Mar Moreno Yangüela a

a Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain

Article

A 29-year-old woman was admitted to the emergency room of our hospital with sudden dyspnea and pleuritic pain. Ten months previously she had had a normal full term delivery, after which she experienced deep venous thrombosis. At emergency room admission, her heart rate was 110 bpm and blood pressure was 90/69 mmHg. An S1Q3T3 pattern was observed on electrocardiography. Computed tomography (CT) study disclosed a massive pulmonary thromboembolism (Figure 1A). Transthoracic echocardiography (TTE) (Figure 1B and C, video 1) showed large masses (white arrows) in both atria, protruding through the 2 atrioventricular valves (Ao, aorta; RA, right atrium; LA, left atrium; RV, right ventricle; LV, left ventricle). We performed 2-dimensional (2D) (Figure 1D-F, video 2) and 3D (Figure 2A and B, videos 3-6) transesophageal echocardiography (TEE), which demonstrated that the patient had a large, morphologically complex mass (white arrow) passing through a patent foramen ovale. The patient was surgically treated with thrombectomy (Figure 2C) and suturing of the foramen ovale. Pathology confirmed the diagnosis of a thrombus. The patient was discharged 1 week later with no incidents.

Figure 1.

Figure 2.

Pulmonary thromboembolism is a common complication of deep venous thrombosis, but demonstration of the thrombus in transit is unusual. Because of the considerable risk of systemic embolism, the treatment of choice is surgical thrombectomy. Although no cases have yet been recorded in the literature, 3D TEE may be useful to accurately show the anatomy of the mass and interatrial septum.

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Appendix A. Supplementary material

Vídeo 1

Vídeo 2

Vídeo 3

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Vídeo 6

Corresponding author: oscarsalvador24@gmail.com

1885-5857/© 2013 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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