Extensive biatrial thrombus straddling the patent foramen ovale and traversing into the left and right ventricle

BMJ Case Rep. 2016 Nov 21:2016:bcr2016216761. doi: 10.1136/bcr-2016-216761.


We report an extremely rare case of an extensive biatrial thrombus straddling a patent foramen ovale (PFO) extending into the bilateral ventricles in a patient presenting with an acute embolic stroke. Our patient further developed a massive saddle pulmonary embolus (PE) with haemodynamic instability during the course of his hospitalisation. The risks of pharmacological thrombolysis or surgical thrombectomy for PE in a haemodynamically unstable patient with recent embolic stroke posed a significant therapeutic dilemma. Ultimately, the decision was made to continue anticoagulation with unfractionated heparin followed by oral Coumadin. The patient responded well to therapy and at 1-month follow-up, a complete resolution of the thrombus was documented on transoesophageal echocardiogram with full clinical recovery of the patient.

Publication types

  • Case Reports

MeSH terms

  • Cerebral Ventricles / pathology*
  • Echocardiography, Transesophageal
  • Foramen Ovale, Patent / pathology*
  • Heparin / therapeutic use
  • Humans
  • Intracranial Thrombosis / drug therapy
  • Intracranial Thrombosis / pathology*
  • Male
  • Middle Aged
  • Stroke / pathology


  • Heparin