Incidental finding of a left atrial thrombus during surgical management of a massive pulmonary embolism

Incidental finding of a left atrial thrombus during surgical management of a massive pulmonary embolism

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A 58-year-old male presented with a hemodynamically significant pulmonary embolism.Computed tomography angiogram revealed a saddle embolus in the main pulmonary artery with extensive clot burden affecting all lobes and right heart strain.Transthoracic Epsom Salts echocardiogram displayed a dilated right ventricle with reduced systolic function.The patient was scheduled for pulmonary embolectomy.The intraoperative transesophageal echocardiogram (TEE) demonstrated Anti-bacterials a mobile left atrial thrombus that was missed on previous imaging.

After removal of the thrombi, TEE showed a patent foramen ovale (PFO).The left atrial thrombus passed across the PFO secondary to increased right heart and pulmonary pressures.