DÄ internationalArchive51-52/2018Simultaneous Diagnosis of Embolisms in the Pulmonary and Systemic Circulation

Clinical Snapshot

Simultaneous Diagnosis of Embolisms in the Pulmonary and Systemic Circulation

Dtsch Arztebl Int 2018; 115: 878. DOI: 10.3238/arztebl.2018.0878b

Adler, C; Freyhaus, H t; Bunck, A

LNSLNS
Transesophageal echo cardiography in modified bicaval projection demonstrates a thrombus (arrow) in transit between the right atrium (RA) and the left atrium (LA)
Transesophageal echo cardiography in modified bicaval projection demonstrates a thrombus (arrow) in transit between the right atrium (RA) and the left atrium (LA)
Figure
Transesophageal echo cardiography in modified bicaval projection demonstrates a thrombus (arrow) in transit between the right atrium (RA) and the left atrium (LA)

A 72-year-old man with dyspnea and fever underwent 10 days’ hospital treatment for suspected pneumonia. Seven days after discharge he was admitted to Cologne University Hospital with left-sided hemiplegia. Magnetic resonance imaging showed cerebral ischemia in the area supplied by the posterior cerebral artery. Routine transesophageal echocardiography detected a highly mobile thrombus in transit which passed from the right to the left atrium via a persisting foramen ovale (PFO) (Figure). The patient’s dyspnea progressed and thoracic computed tomography angiography was carried out. This revealed a bilateral central pulmonary artery embolism, leading to retrospective classification of the initial pneumonia as infarction pneumonia. Immediate heparinization was followed by emergency thrombectomy/embolectomy in combination with closure of the PFO. Further investigation disclosed a lower extremity deep vein thrombosis. The patient was anticoagulated and referred for clinical and echocardiographic follow-up (among other reasons, to check for the development of pulmonary hypertension).

Dr. med. Christoph Adler, PD Dr. med. Henrik ten Freyhaus, Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Christoph.adler@uk-koeln.de

PD Dr. med. Alexander Bunck, Institut für Diagnostische und Interventionelle Radiologie, Universität zu Köln

Conflict of interest statement: The authors declare that no conflict of interest exists.

Translated from the original German by David Roseveare.

Cite this as: Adler C, ten Freyhaus H, Bunck A: Simultaneous diagnosis of embolisms in the pulmonary and systemic circulation.
Dtsch Arztebl Int 2018; 115: 878. DOI: 10.3238/arztebl.2018.0878b

Transesophageal echo cardiography in modified bicaval projection demonstrates a thrombus (arrow) in transit between the right atrium (RA) and the left atrium (LA)
Transesophageal echo cardiography in modified bicaval projection demonstrates a thrombus (arrow) in transit between the right atrium (RA) and the left atrium (LA)
Figure
Transesophageal echo cardiography in modified bicaval projection demonstrates a thrombus (arrow) in transit between the right atrium (RA) and the left atrium (LA)