Bi-atrial thrombus straddling a patent foramen ovale with bilateral embolization: A therapeutic challenge

Stroke is a leading cause of morbidity and mortality across the world and a significant portion of ischemic strokes have a cardiac source. We report a case of a 55-year-old male who presented with an ischemic stroke and bilateral pulmonary emboli secondary to an intra-cardiac thrombus straddling a patent foramen ovale, which was clearly seen using transesophageal echocardiography. We discuss the management dilemma associated with this clinical picture given the risk of hemorrhagic transformation in the acute phase of an ischemic stroke. Our case demonstrates the need for a multidisciplinary approach in an area of medicine that lacks clear guidelines.