Page 17 - Delaware Medical Journal July 2015
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CASE REPORT
FIGURE 2
Transesophageal echocardiography at mid-esophageal view showing a large serpentine like thrombusextending from right atrium into the left atrium via PFO.
CASE DESCRIPTION
A 71-year-old gentleman with a past medical history of hypertension presented to his primary care physician (PCP) with right lower extremity tenderness and edema. Venous ultrasound (Figure 1) While the patient was discussing options for anticoagulation with his PCP, he had a short episode of slurred speech.
Magnetic Resonance Imaging (MRI) showed no signs of acute infarct and a diagnosis of transient ischemia attack (TIA)
was made. The Transthoracic Echocardiogram (TTE) was which was suspicious of thrombus in transient through PFO,
but was not conclusive. The patient was hemodynamically stable, swallowing evaluation showed no issues, TEE showed the presence of a large serpentine like thrombus extending from right atrium into the left atrium via PFO. (Figures 2 and, 3)
The patient was at high risk for a massive stroke of excessive systemic evaluation. A discussion of potential options was
done with cardiothoracic surgery. The available options were surgical intervention with PFO closure and surgical excision of Giving that the patient’s surgical risk was low and the potential emergent cardiac thombectomy and PFO closure (Figure 4) which was tolerated well without complications. The patient did well after surgery and followed up with no further complications afterward.
FIGURE 3
Transesophageal echocardiography with color Doppler at mid-esophageal view showing a large serpentine like thrombus extending from right atrium into the left atrium via PFO.
FIGURE 4
Extracted thrombus in transit after an emergent cardiac thombectomy and PFO closure.
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