Multiorgan paradoxical embolism consequent to acute pulmonary thromboembolism with patent foramen ovale: a case report

Abstract

Paradoxical embolism is defined as a systemic arterial embolism requiring the passage of a venous thrombus into the arterial circulatory system through a right-to-left shunt. It is a relatively rare phenomenon, representing about 2% of all cases of arterial embolism. We report a case of a 79-years-old woman admitted to hospital because of dyspnea and lower left limb pain. CT scan revealed multiple thrombi to kidney, lower limb and superior mesenteric artery during acute pulmonary embolism. Echocardiogram documented a patent foramen ovale with a right-to-left shunt. The patient was treated with thrombolytic therapy and heparin with progressive improvement of symptoms and resolution of pulmonary embolism and peripheral thrombosis. Patent foramen ovale closure was not performed because a life-long anticoagulation therapy was necessary, a tunnel-type patent foramen ovale may increases difficulty in realizing device implantation and there are no clear evidence-based guidelines to date addressing treatment in presence of a patent foramen ovale.

A Case of Cryptogenic Stroke Associated with Patent Foramen Ovale Coexisting with Pulmonary Embolisms, Deep Vein Thromboses, and Renal Artery Infarctions

“…The mechanism of the renal infarction in our case was considered that transiently increased right arterial hypertension, due to acute pulmonary embolism induced continuous opening of PFO and permitted a passage of the thrombi in deep vein into the arterial system 11). It should also be noted that though there have been several case reports of systemic PDEs with PTE associated with PFO,7)8)13) cases of non-cerebral, systemic PDEs, associated with PFO, are relatively lower than for cerebral PDEs. One report showed that only 2.9% of patients with PFO presented with a presumptive diagnosis of systemic embolism,14) though when patients with major pulmonary embolism have PFO, the incidence of peripheral artery embolisms, can significantly be increased (up to 15%) 15)…”

Simultaneous Multifocal Paradoxical Embolism in an Elderly Patient with Patent Foramen Ovale: A Case Report

“…In that case, the patient was initially treated with TPA given her hemodynamic stability and no contraindications to thrombolysis. PFO closure was not performed because long-lasting oral anticoagulation therapy was necessary given the absence of a demonstrated source of systemic emboli [16]. Another study reported by Islam et al [17] described a case of PDE with PFO simultaneously involving four organ systems: pulmonary circulation, cerebrum, left upper extremity, and the coronary artery.…”

Patent foramen ovale: diagnostic evaluation and the role of device closure

“…PFO may be associated with arterial embolisation to the gastrointestinal system, upper or lower limbs, or the coronary circulation (presenting as acute myocardial infarction), to name a few. [36][37][38] Selected cases of a paradoxical systemic embolus in younger patients with an absence for risk factors of atherosclerosis may be potential indications for PFO closure and should be referred to the MDT, if no other source of embolisation can be elucidated.…”