Thrombus straddling a patent foramen ovale, pulmonary embolism and paradoxical embolism: a rare trifecta

Dada, Rachel S.; Dada, Jafar; Abdelsalam, Murad; Agrawal, Yashwant

doi:10.1136/bcr-2018-227505

Cited by 6 publications

(5 citation statements)

References 3 publications

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“…Pulmonary embolism can rapidly increase right-sided pressure of the heart, and a right-to-left shunt can occur even with an extremely small PFO, causing brain embolism. Even in cases of asymptomatic or clinically undetectable PFO in young children, physicians must recognize the risk of paradoxical cerebral embolism caused by increased right-sided pressure of the heart, such as pulmonary embolism [9, 10] because of the high prevalence rate of latent PFO.…”

Section: Discussionmentioning

confidence: 99%

Pediatric acute paradoxical cerebral embolism with pulmonary embolism caused by extremely small patent foramen ovale

et al. 2018

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AbstractHerein, we report a pediatric case of acute paradoxical cerebral embolism complicated by serious acute pulmonary embolism that was caused by an extremely small patent foramen ovale (PFO). The patient had no medical history suggestive of any other reason.Paradoxical cerebral embolism may occur even with an extremely small PFO because of the increased right-side pressure of the heart and a resulting right-to-left shunt from the acute pulmonary embolism. Although pediatric cases of pulmonary embolism are rare, when diagnosed, clinicians should consider the risk of a concurrent paradoxical cerebral embolism resulting from a latent PFO. The possibility of PFO should be assessed extremely carefully in pediatric critical care by checking for a thrombogenesis tendency and the existence of deep vein thrombosis in the patient.

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Section: Discussionmentioning

confidence: 99%

Pediatric acute paradoxical cerebral embolism with pulmonary embolism caused by extremely small patent foramen ovale

et al. 2018

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“…An analysis of 12 anecdotal reports of PE-related PDE [92][93][94][95][96][97][98][99][100][101][102][103][104][105] reveals three patterns of clinical presentation (Table 4), namely, simultaneous occurrence of typical PE symptoms(or hypoxaemia) and symptoms of PDE, occurrence of PE symptoms followed by occurrence of stroke a day or so later, and occurrence of stroke without any documentation of breathlessness. In the latter category were four patients [102][103][104][105] in whom PDE-related stroke occurred in a PE patient who had reported neither breathlessness, chest pain or cough. Nevertheless, subsequent transthoracic echocardiography(TTE) revealed either right heart dilatation and elevation in pulmonary artery systolic pressure [103], or intracardiac thrombus [102,104,105], thereby raising the index of suspicion for PE.…”

Section: Pulmonary Embolism-related Pde (Table 4)mentioning

confidence: 99%

“…In the latter category were four patients [102][103][104][105] in whom PDE-related stroke occurred in a PE patient who had reported neither breathlessness, chest pain or cough. Nevertheless, subsequent transthoracic echocardiography(TTE) revealed either right heart dilatation and elevation in pulmonary artery systolic pressure [103], or intracardiac thrombus [102,104,105], thereby raising the index of suspicion for PE. The utility of TTE in identifying PE in patients with PDE [102][103][104][105] has its counterpart in the utility of TTE for differentiating PE from suspected AMI [106].…”

Section: Pulmonary Embolism-related Pde (Table 4)mentioning

confidence: 99%

“…Nevertheless, subsequent transthoracic echocardiography(TTE) revealed either right heart dilatation and elevation in pulmonary artery systolic pressure [103], or intracardiac thrombus [102,104,105], thereby raising the index of suspicion for PE. The utility of TTE in identifying PE in patients with PDE [102][103][104][105] has its counterpart in the utility of TTE for differentiating PE from suspected AMI [106]. In the latter case report a 32 year old man presented with anterior chest pain and dyspnoea, and he had ST segment elevation in V3-V6.…”

Section: Pulmonary Embolism-related Pde (Table 4)mentioning

confidence: 99%

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Atypical manifestations of pulmonary embolism

Jolobe¹

2020

Arch Vas Med

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Pulmonary embolism (PE) is an age-related disorder which is potentially fatal, but frequently misdiagnosed. However, the true prevalence of pulmonary embolism is unknown. Inaccurate estimates of PE prevalence might, in part, be attributable to underrecognition of atypical presentations of this disorder. If true prevalence is unknown, the positive predictive values of both typical and atypical symptoms and signs of PE will be unreliable. The negative predictive value of those parameters will, likewise, be unreliable. The aim of this review is to make clinicians more aware of atypical manifestations of PE, thereby increasing the likelihood of correct diagnosis and, hence, ascertainment of the true prevalence of PE. The range of atypical manifestations was explored by a literature search, using MEDLINE from using the search terms atypical, uncommon, unusual, pulmonary embolism, lung embolism, pulmonary thromboembolism.This search revealed atypical presenting features such as non pleuritic retrosternal pain, abdominal pain, atypical breathing patterns, pulmonary oedema, Dressler's syndrome, atypical radiographic manifestations, atypical electrocardiographic features, manifestations associated with oxygen saturation of 95% or more, coexistence of acute myocardial infarction and pulmonary embolism, coexistence of thoracic aortic dissection and pulmonary embolism, neurological manifestations other than stroke, paradoxical embolism, acute venous thrombosis of atypical location, and pulmonary embolism with normal D-dimer levels.Atypical manifestations of pulmonary embolism https://www.heighpubs.org/hjvsm 009 https://dx.

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“…Intracardiac thrombus in transit wedged in a PFO is associated with high mortality and morbidity [4]. The combination of a TSFO and acute pulmonary embolism significantly increases the likelihood of the occurrence of paradoxical embolism [5].…”

Section: Introductionmentioning

confidence: 99%

Thrombus straddling patent foramen ovale and massive pulmonary embolism

Panthee

Koirala

Rajbhandari

et al. 2020

Indian J Thorac Cardiovasc Surg

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A thrombus straddling the foramen ovale is rare; and optimal management is controversial. Most of the literature on this topic is available only in the form of case reports. Here, we present a case of 30-year-old female with recent history of fibular fracture and thrombus in transit through patent foramen ovale and massive pulmonary embolism who was successfully managed with pulmonary embolectomy, extraction of serpentine thrombus straddling patent foramen ovale, and closure of patent foramen ovale.

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Thrombus straddling a patent foramen ovale, pulmonary embolism and paradoxical embolism: a rare trifecta

Cited by 6 publications

References 3 publications

Pediatric acute paradoxical cerebral embolism with pulmonary embolism caused by extremely small patent foramen ovale

Pediatric acute paradoxical cerebral embolism with pulmonary embolism caused by extremely small patent foramen ovale

Atypical manifestations of pulmonary embolism

Thrombus straddling patent foramen ovale and massive pulmonary embolism

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