Work

Pulmonary Embolism, Silent Stroke, and an Occult Caval Thrombus

Year: 2026

Type: article

Abstract: BACKGROUND: Clot in transit (CIT) through a patent foramen ovale (PFO) with concomitant pulmonary embolism is a rare condition that carries high mortality and lacks established management guidelines. CASE SUMMARY: A 67-year-old woman presented with 5 days of exertional dyspnea. Echocardiography showed a mobile thrombus traversing the atrial septum through a PFO with right ventricular dysfunction. Computed tomography pulmonary angiography demonstrated a saddle embolus, and brain imaging revealed a clinically silent paradoxical infarct. Compression ultrasonography showed no deep vein thrombosis. During emergency embolectomy with PFO closure, an unsuspected inferior vena cava thrombus was retrieved. DISCUSSION: CIT requires direct assessment of the pulmonary, systemic arterial, and venous axes before reperfusion is selected; computed tomography pulmonary angiography does not reliably assess the inferior vena cava. TAKE-HOME MESSAGE: When CIT is identified, interrogate the caval axis directly rather than inferring it from a negative pulmonary angiogram.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2026.110530

Authors: Truong Q. Le, Nhat M. Giang, Hai H. Nguyen, Thanh M. Bui

Institution: Bệnh viện Nhân dân Gia Định

Language: English

Topic: Cardiovascular and Diving-Related Complications

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850