Saddle pulmonary embolism and clot in transit in COVID-19 infection: A case report of catastrophic venous thromboembolism

Shunsuke Aoi, Amit M. Kakkar, Yosef Golowa, Michael Grushko, Christina M. Coyle, Tarek Elrafei, Matthew D. Langston, Robert T. Faillace, Sripal Bangalore, Seth I. Sokol

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Background: Coronavirus disease 2019 (COVID-19) is associated with a coagulopathy favouring thrombosis over bleeding that imparts a poor prognosis. Clot in transit (CIT) is considered a rare entity and the most severe form of venous thromboembolism (VTE), carrying a higher mortality than isolated pulmonary embolism (PE). The incidence of this phenomenon in patients with COVID-19 infection is unknown and likely under-recognized. Case summary: During the peak of the COVID-19 pandemic in New York City, a 70-year-old Hispanic female presented with syncope due to a saddle PE further complicated by a highly mobile CIT. Polymerase chain reaction was positive for COVID-19 infection, however, there was no evidence of lung parenchymal involvement or hyper-inflammation. Based on consensus from a multidisciplinary team, aspiration thrombectomy was attempted to treat this extreme case of VTE, however, the patient died during the procedure. Discussion: This case raises awareness to the most catastrophic form of VTE, presenting in an early phase of COVID-19 infection without the typical hyper-inflammation and severe lung injury associated with development of COVID-related coagulopathy. It also serves to inform on the critical role echocardiography has in the comprehensive evaluation and re-evaluation of hospitalized patients with COVID-19, and the importance of a multidisciplinary organized approach in clinical decision-making for this complex and poorly understood disease and its sequelae.

Original languageEnglish (US)
Article numberytaa437
JournalEuropean Heart Journal - Case Reports
Issue number6
StatePublished - Dec 1 2020


  • COVID-19
  • Case report
  • Clot in transit
  • Pulmonary embolism

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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