A case of pulmonary thromboembolism with synchronous and metachronous paradoxical embolism through the patent foramen ovale - a case report

Pirkl, Miloslav; Myjavec, Andrej; Daněk, Tomáš; Černý, Miloš

doi:10.1016/j.crvasa.2012.08.001

Cited by 7 publications

(5 citation statements)

References 18 publications

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“…In our case, the left subclavian artery, left common femoral artery and superior mesenteric artery were involved. Paradoxical embolism into superior mesenteric artery is extremely rare (10,11).…”

Section: Discussionmentioning

confidence: 99%

Acute limb ischemia due to paradoxical embolism treated with systemic thrombolysis

Pokorna¹,

Bodíková²,

Kaluzay³

et al. 2020

Vnitr Lek

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We present a case report of a patient with acute upper and lower limb ischemia due to paradoxical embolism. A 67-year old woman without history of venous thromboembolism suffered dislocated patellar fracture requiring surgery in November 2017. Two months after surgery she presented to the emergency room with bilateral pulmonary embolism, occlusion of the left subclavian artery, left common femoral artery and superior mesenteric artery. Transesophageal echocardiography detected patent foramen ovale. Vascular surgeon decided against embolectomy, interventional radiologist against pharmacomechanical thrombolysis due to the extent of the occlusions. Systemic thrombolysis (alteplase) was administered successfully with resolution of the emboli in the left subclavian artery, left common femoral artery and superior mesenteric artery.

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Section: Discussionmentioning

confidence: 99%

Acute limb ischemia due to paradoxical embolism treated with systemic thrombolysis

Pokorna¹,

Bodíková²,

Kaluzay³

et al. 2020

Vnitr Lek

View full text Add to dashboard Cite

show abstract

“…The sequelae of paradoxical embolism may vary depending on the site of embolisation and these may include stroke in 55% of cases, acute peripheral arterial limb occlusion in 40% of cases, coronary artery occlusion leading to myocardial infarction, and mesenteric, renal and retinal artery occlusion 2 3…”

Section: Discussionmentioning

confidence: 99%

“…Paradoxical embolism is a rare cause of arterial embolism, involving the passage of thrombi from the venous circulation into the systemic arterial circulation through a right to left cardiac shunt 1 2…”

Section: Introductionmentioning

confidence: 99%

Systemic and venous thromboembolism: think about paradoxical embolism

et al. 2015

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Patent foramen ovale (PFO) is one of the most important causes of paradoxical embolism; it is found in about 25-30% of the population. In most patients, it is asymptomatic and diagnosis is usually made during routine echocardiography. In a small proportion of patients, PFO is diagnosed after paradoxical embolism is suspected. We present a case of a middle-aged smoker who was admitted with lower limb deep vein thrombosis and pulmonary embolism, who developed acute upper limb ischaemia during his inpatient stay. Since doctors might dismiss such cases as routine, this report highlights the importance of detailed history taking and examination in patients with venous thromboembolism. Paradoxical embolism should always be considered as a possible diagnosis when managing patients with concomitant venous and arterial embolism.

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“…the presence of an atrial or ventricular septal defect. 1,2 The cardiac defect enables venous clot material to pass into the arterial circulation. Common end organs affected include brain, extremities, bowel, and kidneys.…”

Section: Case Reportmentioning

confidence: 99%

A patient with multiple paradoxical emboli

Liu

Menzoı́an

2016

Journal of Vascular Surgery

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We present a case report of simultaneous pulmonary emboli and paradoxical embolism to the cerebellum causing a stroke and severe ischemia to the left leg. This patient had risk factors for thromboembolic events that included autoimmune disease, cancer, and recent pelvic surgery. The presence of a perforate foramen ovale was suspected on his initial presentation and confirmed with echocardiography. For acute leg ischemia, this patient underwent emergent left common femoral embolectomy. The potential benefit of immediate anticoagulation had to be weighed against the risk of hemorrhagic transformation of his cerebellar stroke with possible compression of the fourth ventricle. In the end, full anticoagulation was delayed with interval placement of a retrievable inferior vena cava filter. This case illustrates the challenges faced in treating a patient with multiple paradoxical emboli. (J Vasc Surg 2015;-:1-3.) CASE REPORTConsent was obtained from the patient to publish this case report along with the images. The patient is a 57-year-old man who presented to the emergency department with a 12-hour history of vertigo, nausea, left leg weakness, and shortness of breath at rest. He was unable to get out of bed as lifting his head off the pillow led to a sensation that "everything was spinning." He also complained of escalating pain followed by numbness and weakness in his left foot. In addition, his shortness of breath was unusual for him as he normally walked about a mile a day for exercise.Pertinent past medical history included Wegener granulomatosis, transitional cell bladder cancer, hypertension, and venous thromboembolism. He completed a 12-month course of systemic anticoagulation after a pulmonary embolus developed 5 years ago. At that time, the patient was evaluated for a possible hypercoagulable syndrome and none was found. The patient had undergone a radical cystoprostatectomy with neobladder creation for bladder cancer about 2 months before this current presentation.On physical examination, the patient was noted to have nystagmus with head movement. He had significant dysmetria. Speech was slurred but otherwise intact. There was no facial droop. His left lower extremity was white and insensate below the knee. There was minimal plantar flexion, and the left foot was paralyzed. There was no pulse in the left leg. A Doppler signal was present in the left femoral artery. Neurovascular examination findings of the right lower extremity were unremarkable.Pertinent diagnostic imaging included computed tomography (CT) of the head, showing an acute right cerebellar infarct (Fig 1); CT angiography of the chest, showing bilateral pulmonary emboli (Fig 2); and CT of the abdomen and pelvis (done as part of the workup for nausea), showing an acute cutoff at the left common femoral artery.At this point, the patient was diagnosed with a cerebellar stroke, pulmonary emboli, and critical ischemia of the left lower extremity. He was taken emergently to the operating room, where a left common femoral artery embolectomy was perform...

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A case of pulmonary thromboembolism with synchronous and metachronous paradoxical embolism through the patent foramen ovale - a case report

Cited by 7 publications

References 18 publications

Acute limb ischemia due to paradoxical embolism treated with systemic thrombolysis

Acute limb ischemia due to paradoxical embolism treated with systemic thrombolysis

Systemic and venous thromboembolism: think about paradoxical embolism

A patient with multiple paradoxical emboli

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