title: Systemic thrombolysis using tissue plasminogen activator for a patient with paradoxic embolism: a case report.
abstract: When thrombotic material that originates from deep venous thrombosis of the lower extremities is washed out into the pulmonary vasculature, pulmonary embolization occurs. Pulmonary embolism and associated acute peripheral ischemia suggest the diagnosis of paradoxic embolism, which is most often associated with a patent foramen ovale. Therapeutic options include anticoagulation, mechanical/chemical thrombus dissolution, inferior vena cava filtration, and closure of the intracardiac defect. The diagnosis and treatment are described of an elderly female who presented with lower extremity deep venous thrombosis and massive pulmonary embolism complicated by paradoxic emboli to the left subclavian artery as well as the celiac artery.
authors.affiliation: Department of Surgery, Good Samaritan Hospital, Cincinnati, Ohio 45220, USA. Joy_Rusche@trihealth.com
authors.forename: Zhen
authors.initials: Z
authors.lastname: Fan
authors.forename: Richard
authors.initials: R
authors.lastname: Roedersheimer
authors.forename: Joann
authors.initials: J
authors.lastname: Lohr
mesh_terms: D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000473:pathology / Q000601:surgery; D002445:Celiac Artery / Q000473:pathology / Q000601:surgery; D019320:Embolism, Paradoxical / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D005268:Femoral Vein / Q000473:pathology / Q000601:surgery; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006344:Heart Septal Defects, Atrial / Q000601:surgery; D006801:Humans; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D013348:Subclavian Artery / Q000473:pathology / Q000601:surgery; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D018608:Ultrasonography, Doppler; D014656:Vascular Surgical Procedures; D020246:Venous Thrombosis / Q000188:drug therapy
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator