Extract

A 68-year-old female with a history of deep venous thrombosis was admitted for progressive exertional dyspnoea with mild dizziness. Transoesophageal echocardiography revealed a large mobile thrombus of 30 × 3.4 mm in size that straddled a patent foramen ovale (PFO), exhibiting a ‘butterfly sign’ (Panel A and Supplementary data online, Video S1). Pulmonary CT angiography (CTPA) revealed fresh thrombus in the right main pulmonary artery and its branches (Panel B). Given the symptom of dizziness, cerebral magnetic resonance imaging was performed, which detected an embolus in the right temporal lobe (Panel C). CT angiography of the coronary arteries, aorta, and its branches revealed no thrombus. The patient was given rivaroxaban for anticoagulation. Transoesophageal echocardiography at one month showed the thrombus straddling the PFO disappeared (Panel D). Meanwhile, CTPA identified no thrombus in the pulmonary trunk and the left and right pulmonary arteries, suggesting alleviation of pulmonary embolism (Panel E). Subsequently, transcatheter closure of the PFO was performed (Panel F).

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