Imaging in cardiology

Figure 1. Transoesophageal echocardiogram of the described patient showing a thrombus in transit ' in the riht atrium, stuck in the foramen ovate. Afloating cather is also visible in the riht atrium. (Illustration: Rien Gommers) Thrombus In transit A 61-year-old man had driven from Denmark to the Netherlands. Having reached his destination, he complained ofdizziness and shortness of breath. On physical examination his blood pressure was 65/40 mmHg, with a regular pulse of 130 beats/min. The patient complained of shortness of breath. No ab-normalities of the heart and lungs were found. Examination of the abdomen and the extremities revealed no abnormalities. The X-ray ofthe chest and the electrocardiogram were normal. The laboratory investigation on admis-sion showed the following values for the arterial blood gas analysis: pH: 7.42 (normal value 7.35-7.45); pCO2: 3.4 kPa (4.2-6.2); p02: 6.7 kPa (9.5-13); 02 saturation: 0.85 mmol/mmol (0.95-1.0). Creatinine 150,umol/l (50-110). These investigations were interpreted as hyposaturation with hyperventilation and a mild renal dysfunction. Transoesophageal echocardiography was performed because of suspected pulmonary embolism.'13 With this investigation an elongated, mobile 'thrombus in transit ' was visualised, stuck to the foramen oval