case_images: PMC11732528_01
case_images: A, Clot-in-transit (CIT) within the right atrium as demonstrated on transesophageal echocardiogram (TEE) and marked with an orange arrow. B, TEE performed 1 day after the suction thrombectomy demonstrating that the CIT is no longer present in the right atrium or right ventricle (RV).
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case_images: Fig 1, B demonstrating resolution of the CIT postoperatively), and a moderate PFO with a significant right-to-left shunt. Fig 2 demonstrates a PE that was presumed to be an FE based on the Hounsfield units. Fat can be distinguished from VTE because the attenuation value of fat is between -50 Hounsfield units (HU) to -150 HU, whereas VTE is 33 HU. TEE (Fig 1, B), and the thrombus adherent to the central line was also suctioned under intravascular ultrasound guidance (Fig 5), which was done to reduce the risk of progression, considering poor baseline cardiac function and a moderate PFO in the context of continuous contraindication to anticoagulation and high clinical suspicion of FEs. The
case_images: Computed tomography pulmonary angiogram (CTPA) demonstrating small pulmonary emboli (PE) presumed to be fat embolism (FE) based on the Hounsfield units (HUs), which has been rotated with three-dimensional multiplanar reconstruction to better visualize the FE, which is marked with orange arrows.
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case_images: Fig 1, B demonstrating resolution of the CIT postoperatively), and a moderate PFO with a significant right-to-left shunt. Fig 2 demonstrates a PE that was presumed to be an FE based on the Hounsfield units. Fat can be distinguished from VTE because the attenuation value of fat is between -50 Hounsfield units (HU) to -150 HU, whereas VTE is 33 HU.
case_images: Digital subtraction imaging demonstrating the positioning of the echocardiogram probe and vascular catheters to assist in positioning to locate the clot-in-transit (CIT).
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case_images: From the left side, another wire, followed by an intravenous ultrasound .035 catheter (Philips Volcano Visions), was also positioned in the right IJV; however, the TEE was better at demonstrating thrombus in the right atrium, RV, and over the CVC (Figs 3 and 4).
case_images: Intravascular ultrasound demonstrating thrombotic material in the right atrium demonstrated with a superimposed arrow.
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case_images: fig4
case_images: From the left side, another wire, followed by an intravenous ultrasound .035 catheter (Philips Volcano Visions), was also positioned in the right IJV; however, the TEE was better at demonstrating thrombus in the right atrium, RV, and over the CVC (Figs 3 and 4).
case_images: Photograph of the thrombotic material removed from the superior vena cava, right atrium, and right ventricle (RV) using the Inari FlowTriever suction thrombectomy system.
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case_images: PMC11732528_01_gr5.jpg
case_images: fig5
case_images: TEE (Fig 1, B), and the thrombus adherent to the central line was also suctioned under intravascular ultrasound guidance (Fig 5), which was done to reduce the risk of progression, considering poor baseline cardiac function and a moderate PFO in the context of continuous contraindication to anticoagulation and high clinical suspicion of FEs. The
case_images: Histological slides demonstrating hemorrhage and fibrin with the empty spaces demonstrating fat vacuoles.
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case_images: There are no atypical features." Histopathological slides are demonstrated in Fig 6.