Straddling embolus across patent foramen ovale in a case of pulmonary embolism

Acute pulmonary embolism has a significant impact on morbidity and mortality. Its presentation varies from asymptomatic, incidentally discovered subsegmental thrombi to massive pulmonary embolism complicated by cardiogenic shock and multisystem organ failure. We present a case of a 37-year-old male who had deep venous thrombosis with acute massive pulmonary embolism and stroke. Transesophageal echocardiography revealed large straddling thrombus in patent foramen ovale along with branch pulmonary artery embolus. Patent foramen ovale was closed and pulmonary artery embolus was removed surgically. We conclude that surgery is the best mode of management in the presence of patent foramen ovale.