Transient Bilateral Atrial Thrombi in a Patient With Multiple Sclerosis and Massive Pulmonary Embolism: A Case Report and Review of the Literature

TL;DR

A 67-year-old woman with multiple sclerosis had a complex case involving blood clots and a stroke, highlighting the challenges in diagnosing overlapping heart and brain issues.

Contribution

This case report highlights diagnostic challenges in patients with multiple sclerosis and transient atrial thrombi.

Findings

The patient had bilateral pulmonary embolism and bi-atrial thrombi without confirmed intracardiac shunt.

Anticoagulation led to thrombus resolution and clinical improvement.

The case emphasizes the difficulty in distinguishing stroke from MS relapse.

Abstract

Pulmonary embolism (PE) can present with complex and atypical features that challenge diagnosis and management, particularly when coexisting with intracardiac thrombi and neurological symptoms. We report a case of a 67-year-old woman with multiple sclerosis (MS) who presented with bilateral PE, bi-atrial thrombi, and a subsequent embolic stroke. Despite initial imaging suggesting a possible atrial septal defect (ASD) as the route for paradoxical embolism, both transthoracic echocardiography and cardiac magnetic resonance imaging failed to confirm any intracardiac shunt. The case underscores the diagnostic difficulties in differentiating between stroke and MS relapse, as well as limitations of imaging modalities in transient thrombotic or shunt-related phenomena. The patient was managed with therapeutic anticoagulation, which resulted in thrombus resolution and clinical improvement. This case highlights the need for high clinical suspicion and multidisciplinary evaluation in patients with overlapping cardiovascular and neurological presentations, especially in the setting of chronic inflammatory diseases such as MS.

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