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Ann Card Anaesth. 2020 Jan-Mar;23(1):87-89. doi: 10.4103/aca.ACA_119_18.

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

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Department of Anesthesiology, Jackson Memorial Hospital, Miami, FL, USA.


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 echocardiogram displayed a dilated right ventricle with reduced systolic function. The patient was scheduled for pulmonary embolectomy. The intraoperative transesophageal echocardiogram (TEE) demonstrated 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.


Left atrial thrombus; patent foramen ovale; pulmonary embolism; right ventricular failure; right-to-left shunt

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