Extensive Pulmonary Thromboembolism and Serious Threat of Systemic Thromboembolism in a Suspected COVID Recovered Patient

Hemodynamically significant large pulmonary embolism causes right ventricular dysfunction that stretches open the foramen ovale in the atrial septum. Paradoxical embolism is common in patients with right ventricular dysfunction. While anticoagulation and thrombolysis are considered the treatment of choice in pulmonary embolism, a large thrombus in transit across the patent foramen ovale carries a serious risk of systemic thromboembolism and warrants urgent surgery. The recent coronavirus disease 2019 (COVID-19) pandemic has led to a significant increase in the incidence of thromboembolic illnesses. A patient acutely presented with deep vein thrombosis, pulmonary embolism, large thrombus in transit across the foramen ovale along with elevation of multiple inflammatory biomarkers that were suggestive of a possible post-COVID sequelae. Images and management strategies are discussed in this report.