title: [Paradoxical embolism in a patient with aneurysm of the interatrial septum].
abstract: We report a case of pulmonary embolism complicated by paradoxical cerebral embolism in a patient with atrial septal aneurysm and patent foramen ovale. The patient was a 65-year-old obese woman, admitted because of sudden development of right-sided hemiplegia and dysarthria. In the few days before hospitalization she noted painful edema of the right leg and suffered from increasing dyspnea. Echo-Doppler examination of the venous bed confirmed the clinical suspicion of deep vein thrombosis. A pulmonary scan showed multiple perfusion defects in both lungs. On cerebral computerized tomography there were two non-haemorrhagic infarct zones. Contrast transesophageal echocardiography revealed a type II atrial septal aneurysm with right-to-left shunting through a patent foramen ovale. The patient was treated by warfarin, followed by implantation of a caval filter, with a good outcome. Paradoxical embolism may be more common than currently thought. In cases of pulmonary embolism, a careful check for clinical symptoms indicative of a possible paradoxical embolism should be performed and, consequently, a search for possible atrial septal aneurysm or patent foramen ovale.
authors.affiliation: Divisione di Cardiologia, Ospedale SS. Annunziata, Savigliano, CN.
authors.forename: E
authors.initials: E
authors.lastname: Antonielli
authors.forename: P
authors.initials: P
authors.lastname: Pieroni
authors.forename: A
authors.initials: A
authors.lastname: Pizzuti
mesh_terms: D000368:Aged; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005260:Female; D006322:Heart Aneurysm / Q000150:complications* / Q000000981:diagnostic imaging; D006325:Heart Atria; D006344:Heart Septal Defects, Atrial / Q000150:complications; D006346:Heart Septum; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D011655:Pulmonary Embolism / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D013924:Thrombophlebitis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D014057:Tomography, X-Ray Computed; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D014859:Warfarin
vernacular_title: Embolia paradossa in una paziente affetta da aneurisma del setto interatriale.