Biatrial Thrombi

A 58-year-old woman with no relevant medical history developed left calf tightness and pain after a long flight followed by shortness of breath and syncope. She had a temperature of 36.8°C, a heart rate 102 beats/minute, a blood pressure of 128/66 mm Hg, a respiratory rate 20 breaths/minute, normal oxygen saturation, a troponin level of 0.07 ng/mL (to convert to micrograms per liter, multiply by 1), and a fibrin D-dimer of more than 2000 μg/mL (to convert to nanomoles per liter, multiply by 5.476). Chest computed tomography showed multiple large bilateral pulmonary emboli with deviation of the interventricular septum towards the left ventricle. This video illustrates a large mobile thrombus extending from the right atrium into the right ventricle and clot in the left atrium and left ventricle appearing to originate from the interatrial septum on echocardiography. The patient was taken for an emergency controlled operative thrombectomy; a 9-cm clot extending across a patent foramen ovale was removed via right atriotomy, and the patent foramen ovale was closed. Click the related article link for full case details, including the patient’s outcome.