Right atrial thrombus and paradoxical embolism risk in a trauma patient with patent foramen ovale: case report.

Background: Cardiac masses include thrombi, vegetations, and tumours, each requiring tailored treatment. Right atrial thrombi, often linked to venous thromboembolism, risk pulmonary embolism, while left-sided thrombi pose systemic embolization risks. Management ranges from anticoagulation to surgical or percutaneous intervention based on stability and embolization risks. Case summary: A 57-year-old man presented with multi-trauma and intracranial bleeding. Transthoracic echocardiography revealed a thrombus in the right atrium, alongside a large patent foramen ovale (PFO) with atrial septal aneurysm. The thrombus posed a dual embolic risk: pulmonary embolism or paradoxical embolism via the PFO. Due to contraindications for anticoagulation, an urgent procedure was performed with FlowTriever® to extract the thrombus. A cerebral protection device was deployed to safeguard the supra-aortic trunks, and a sizing balloon was inflated to temporarily occlude the PFO. Discussion: We report a case of multidisciplinary management of a right atrial thrombus in a trauma patient at high bleeding risk in the presence of a PFO. Mechanical thrombectomy and temporary PFO occlusion can be utilized to prevent embolism, while PFO closure could be deferred to avoid bleeding complications in a high bleeding context.