# Giant intracardiac thrombus-in-transit in a woman with sudden respiratory-haemodynamic compromise following cesarean section for eclampsia: a case report

## TL;DR

A woman with a rare heart condition and pregnancy complications had a life-threatening blood clot that was successfully removed through emergency surgery.

## Contribution

The case highlights the importance of rapid echocardiography and multidisciplinary intervention in managing intracardiac thrombus-in-transit.

## Key findings

- A large intracardiac thrombus-in-transit was detected and surgically removed in a critically ill patient.
- Histopathology confirmed the mass contained thrombotic and amniotic fluid elements.
- Early surgical intervention led to a full recovery and confirmed acute pulmonary embolism post-surgery.

## Abstract

Intracardiac thrombus-in-transit is a potentially fatal condition, seldom detected in real time.

We present a case of a 30-year-old pregnant woman with thalassemia intermedia and asplenia, who experienced a combined respiratory-haemodynamic collapse following an emergent caesarean section performed for eclampsia, and in whom a large mass transversing a patent foramen ovale was observed on bedside echocardiography. In view of the patient’s unstable condition, mass’ size and location as well as accompanying inter-atrial communication—all of which contributed to an imminent threat to cerebral circulation—and temporal proximity to abdominal surgery and epidural anaesthesia, an immediate open-heart surgery was decided upon that included mass excision and patent foramen ovale closure, and after which the patient quickly and fully recovered. Histopathologic examination of the mass revealed a mixture of thrombotic and amniotic fluid elements. Acute pulmonary embolism was eventually confirmed by computed tomography performed on post-operative day 2.

Early echocardiography and surgical intervention, as dictated by a multidisciplinary collaboration, allowed for a favourable outcome in our patient, emphasizing their pivotal role in the management of a life-threatening presentation of an intracardiac thrombus-in-transit.