Paradoxical Embolus in Transit

Worku, Berhane; Gulkarov, Iosif; Steele, Jeremy; Kadosh, Bernard; Skubas, Nikolaos J.; Girardi, Leonard N.; Salemi, Arash

doi:10.1016/j.athoracsur.2013.09.068

Cited by 8 publications

(5 citation statements)

References 8 publications

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“…Thrombolysis is a fast, widespread and effective treatment, but it bears the risk of thrombus dislocation with paradoxical arterial embolism and irreversible ischemia [6]. Some systematic retrospective reviews have shown that surgical treatment compared to anticoagulation or thrombolysis is associated with a significantly lower 60-day mortality rate and a lower percentage of embolic events compared to other treatment options [5,6]. Thrombolysis or anticoagulation are equally acceptable therapeutic alternatives in patients with hemodynamic instability and in the absence of contraindications [7].…”

Section: Discussionmentioning

confidence: 99%

Biatrial Thromboembolism with Paradoxical Embolism Through Persistent Foramen Ovale

Danov

2020

Acta Medica Bulgarica

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We present a case of a biatrial thrombus penetrating through the PFO against the background of massive bilateral pulmonary thromboembolism in a 75-year-old patient. Because of the rare condition, there are no literature data on consensus treatment. Due to the patient’s clinical status and the results of the diagnostic tests, for the specific clinical case was made a decision for emergency surgical thrombectomy with PFO closure.

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Section: Discussionmentioning

confidence: 99%

Biatrial Thromboembolism with Paradoxical Embolism Through Persistent Foramen Ovale

Danov

2020

Acta Medica Bulgarica

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“…1 Paradoxical embolism is a rare finding, with only 13 cases published in the past 5 years (Table ). [2][3][4][5][6][7][8][9][10][11][12] Sequelae include pulmonary embolism and stroke, often with devastating outcomes. Management remains controversial.…”

Section: Discussionmentioning

confidence: 99%

Paradoxical Thrombus ‘Caught in the Act’: Case Report and Review of the Literature

Sultan

Allen

Sharif

et al. 2017

The American Journal of Medicine

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“…5 This exceedingly rare finding definitively proves the diagnosis of paradoxical embolism. 6 In most cases, the diagnosis is made with radiologic evidence of arterial embolism, deep venous thrombosis, and PFO.…”

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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Paradoxical Embolus in Transit

Cited by 8 publications

References 8 publications

Biatrial Thromboembolism with Paradoxical Embolism Through Persistent Foramen Ovale

Biatrial Thromboembolism with Paradoxical Embolism Through Persistent Foramen Ovale

Paradoxical Thrombus ‘Caught in the Act’: Case Report and Review of the Literature

A patient with multiple paradoxical emboli

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