Bhat Vijeth, Lane Stuart, Orde Sam
John Hunter Hostpial, Intensive Care Unit, New Lambton Heights, New South Wales, Australia
Intensive Care Unit, Nepean Hospital ICU, Kingswood, New South Wales, Australia.
BMJ Case Rep. 2021 Apr 13;14(4):e240957. doi: 10.1136/bcr-2020-240957.
A 60-year-old man was admitted to intensive care unit with the diagnosis of pulmonary embolism. Bedside transthoracic echocardiography revealed the extension of the thrombus into left atrium and ventricle through patent foramen ovale (PFO). A straddling thrombus also described as impending paradoxical embolism is a rare condition when thrombus embolised to the heart gets caught in PFO. Morbidity is extremely high in case of systemic embolisation. Due to rarity, the treatment options are mainly individualised and no guidelines exist. There are few treatment strategies described in literature from surgical to interventional radiology to conservative approach. Treatment strategy should take individual parameters such as patient's age, haemodynamic stability, bleeding risk and comorbidities into consideration. Our patient successfully underwent emergency surgical thrombectomy.
一名60岁男性因肺栓塞诊断入住重症监护病房。床旁经胸超声心动图显示血栓通过卵圆孔未闭（PFO）延伸至左心房和心室。一种被描述为即将发生反常栓塞的骑跨血栓是一种罕见情况，即栓子进入心脏后卡在PFO中。发生系统性栓塞时，发病率极高。由于其罕见性，治疗方案主要是个体化的，目前尚无指南。文献中描述的治疗策略从手术到介入放射学再到保守方法，种类很少。治疗策略应考虑患者年龄、血流动力学稳定性、出血风险和合并症等个体参数。我们的患者成功接受了急诊手术取栓术。
