Large thrombus entrapped in a patent foramen ovale complicated by stroke and pulmonary embolism.

690 parietal-temporal-occipital region of the left brain hemisphere (FIGURE 1AB). Transthoracic echocardiography (TTE) demonstrated dilated right heart cavities with right ventricular hypokinesis, elevated arterial pulmonary pressure of 51 mmHg, and a floating echogenic mass of 10 × 40 mm in the right atrium (RA). Transesophageal echocardiography (TEE) revealed a large 55-mm long thrombus in the RA passing through PFO to the left atrium and partly moving during contraction to the left ventricle (FIGURE 1C–F). Owing to a very high probability of pulmonary embolism (PE) on TTE and TEE, we decided not to perform CT pulmonary angiography. Because the patient did not agree to surgical thrombectomy, a treatment with enoxaparine was started. After 11 days of therapy with low-molecular-weight heparin, control TEE revealed no thrombus in heart cavities (FIGURE 1D). The patient was scheduled for percutaneous closure of the PFO and discharged after the procedure on the 22nd day of hospitalization. A thrombus trapped in the PFO is a very rare finding, mainly manifesting with paradoxical Patent foramen ovale (PFO) is an increasingly studied cause of paradoxical embolism, which may lead to cryptogenic stroke. Owing to its transient nature, it is virtually impossible to identify the embolus at the time of clinical presentation. Echocardiography and other noninvasive imaging modalities remain the basic diagnostic tools in this condition. Because of its rarity, the management of PFO-trapped thrombi has not been well established so far. We report a very rare case of a large thrombus entrapped in PFO complicated by pulmonary embolism and ischemic stroke, successfully treated noninvasively. A 69-year-old extremely obese woman presented at the Department of Neurology with a 1-day history of aphasia, shortness of breath, unspecified chest pain, and dyspnea. A physical examination at baseline revealed mixed sensorimotor aphasia, right Babinski sign, heart rate of 66 bpm, blood pressure of 150/80 mmHg, and oxygen saturation of 96% without oxygen supplementation. A computed tomography (CT) scan showed acute stroke of the left half of the cerebellum and