Page 16 - Delaware Medical Journal July 2015

Thrombus in Transit through a Patent Foramen Ovale: Surgical Prevention of Impending Stroke
Zaher Fanari, MD; Sumaya Hammami, MD, MPH; Usman Choudhry DO, MPH; Asim A. Mohammed, MBBS; Mark Zweben, MD; and Wasif Qureshi, MD
A Transesophageal Echocardiography (TEE) is essential in identifying thrombus in transient in patients with deep venous thrombosis (DVT) presenting with symptoms suggesting potential systemic emboli. We present a case of a 71-year-old gentleman with recent DVT who developed slurred speech and was assumed to have transient ischemia attack (TIA). TEE showed the presence of a large Thrombus in Transit (TIT) through a patent foramen ovale (PFO). Surgical intervention in low to intermediate risk is probably the best option associated with fewer complications of recurrent embolic events than both thrombolysis and anticoagulation.
Key Words: Thrombus in transit, transesophageal echocardiography, deep venous thrombosis, patent foramen ovale, transient ischemia attack
IntroductionMost ischemic strokes are due to cardioembolism,
large vessel athero-thromboembolism, small vessel occlusive disease, or other unusual mechanisms. However, some ischemic as cryptogenic. Atrial septal abnormalities including patent foramen ovale (PFO), atrial septal defect (ASD), and atrial septal aneurysm (ASA) were suggested as potential cause of cryptogenic stroke.1 In patients with deep venous thrombosis( DVT) and concomitant stroke, atrial septal abnormalities correlation with stroke becomes more potential suspect.1
In most of the cases, even when atrial septal abnormality is suspected, due to the transient nature of the “thrombus in transient (TIT),” it is virtually impossible to identify the embolus at the time of clinical presentation. However, starting in 1985 and with improvement of cardiac imaging, a few rare cases of thrombus in transient through PFO were reported.2,3
A Transesophageal Echocardiography (TEE) is essential in identifying thrombus in transient in patients with deep venous thrombosis (DVT) presenting with symptoms suggesting potential systemic emboli.4
FIGURE 1
Venous Doppler shows deep venous thrombosis in right common femoral vein.
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Del Med J | July 2015 | Vol. 87 | No. 7
Abstract