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Case Reports in Cardiology
Volume 2017, Article ID 6752709, 4 pages
https://doi.org/10.1155/2017/6752709
Case Report

Saddle Pulmonary Embolism with Thrombus in Transit across a Patent Foramen Ovale

1Harlem Hospital Center, New York City, NY, USA
2Columbia University Medical Center, New York City, NY, USA
3Department of Cardiology, Harlem Hospital Center, New York City, NY, USA

Correspondence should be addressed to Fitzgerald Shepherd; moc.liamg@78pehsf

Received 25 September 2016; Revised 28 December 2016; Accepted 10 January 2017; Published 26 January 2017

Academic Editor: Filippo M. Sarullo

Copyright © 2017 Fitzgerald Shepherd et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

This is the case of a 25-year-old obese man who presented with acute shortness of breath, chest pain, and palpitations. Of note, he lives a sedentary lifestyle and was recently hospitalized for incision and drainage of a left foot abscess. On presentation he was tachypnoeic, tachycardiac, and hypoxic but blood pressure was stable. Laboratory studies were significant for elevated D-dimer and mildly increased troponin. On further investigation he was found to have a saddle pulmonary embolism with massive clot burden. Echocardiogram revealed thrombus in transit and McConnell’s sign. He underwent surgical embolectomy and closure of a patent foramen ovale. This is a particularly rare case, especially in such a young patient. Because this is a rare diagnosis, with insufficient data, there is no formally established treatment guideline. However, in patients who are good surgical candidates, studies have shown better outcome with surgical embolectomy as compared to anticoagulation alone or thrombolysis.