case_images: PMC10484647_01
case_images: Previous CT and venous echography findings. Previous CT showed bilateral PE (white arrows (a)) and venous echography showed a mobile-shaped thrombus (white arrows) at the proximal site of the left common femoral vein (b). CT: computed tomography, PE: pulmonary embolism, PA: pulmonary artery, CFV: common femoral vein, Th: thrombus.
case_images: CRIEM2023-8829652.001.jpg
case_images: PMC10484647_01_CRIEM2023-8829652.001.jpg
case_images: fig1
case_images: Computed tomography (CT) showed PE in the bilateral pulmonary artery (PA) and venous thrombus from the left popliteal vein to the left common femoral vein (CFV) (Figure 1(a) and 1(b)).
case_images: Preoperative TTE and CT findings. TTE showed dilatation of the right heart system and a newly mobile thrombus (white arrows) in the right atrium with protrusion into the left atrium through the PFO (yellow arrows (a)). CT showed extended thrombosis formation of the left main PA (yellow arrows) in addition to preexisting bilateral PE (white arrows (b)) and occluded IVCF by trapped venous thrombus (c). Yellow arrows indicated the trapped thrombus by IVCF. The thrombus was located at the proximal site of the IVCF. TTE: transthoracic echocardiography, CT: computed tomography, PA: pulmonary artery, PE: pulmonary embolism, IVCF: inferior vena cava filter, RA: right atrium, RV: right ventricle, LA: left atrium, LV: left ventricle, PFO: patent foramen ovale, Th: thrombus.
case_images: CRIEM2023-8829652.002.jpg
case_images: PMC10484647_01_CRIEM2023-8829652.002.jpg
case_images: fig2
case_images: TTE showed a large thrombus, almost 5 cm in size, which was entrapped in the PFO and protruded into the left atrium (Figure 2(a)). TIVCF (Figure 2(c)).
case_images: Intraoperative picture, resected thrombus, and postoperative CT findings. Intraoperative picture showed an entrapped large thrombus in the PFO (a) and resected large thrombus (b). Yellow arrows indicated the PFO, and white arrows indicated an entrapped thrombus, respectively (a). Postoperative CT showed the disappearance of the thrombus in the left main PA (c). White arrows indicated the residual thrombus in the left PA. PFO: patent foramen ovale, CT: computed tomography, PA: pulmonary artery, Th: thrombus.
case_images: CRIEM2023-8829652.003.jpg
case_images: PMC10484647_01_CRIEM2023-8829652.003.jpg
case_images: fig3
case_images: A large thrombus entrapped in the PFO was revealed after opening the RA (Figure 3(a)). The most explanted thrombi were composed of old thrombus (Figure 3(b)). Postoperative CT showed the disappearance of the left main PA thrombus with residual chronic thrombus at the bilateral distal PA without systemic embolism (Figure 3(c)).