Traversing boundaries: thrombus in transit with paradoxical embolism.
A 72-year-old male is diagnosed with paradoxical embolus after he presented with concurrent deep vein thrombosis, stroke, and multiple arterial emboli in the presence of a patent foramen ovale (PFO). Paradoxical embolus requires the passage of a thrombus from the venous into the arterial circulation through a right-to-left shunt leading to systemic embolism. But, despite the high incidence of PFO (27.3% across all age groups by autopsy), paradoxical embolism (PDE) is uncommon, representing <2% of all arterial emboli. We present a case report where a thrombus has been directly observed passing through the PFO during an echocardiogram study; thus, clearly delineating the true cause of multiple thromboemboli and stoke in our patient. Subsequent Transesophageal Echocardiography (TEE) also interestingly showed the thrombus in transit in the aorta and pulmonary artery.
Seton Hall University School of Health and Medical Sciences (St Francis) Program, Trenton, NJ, USA; vmiriyala@stfrancismedical.org.
Varun
V
Miriyala
Seton Hall University School of Health and Medical Sciences (St Francis) Program, Trenton, NJ, USA.
Muhammad Umer
MU
Awan
Capital Health Regional Medical Center, Trenton, NJ, USA.
Kirmanj
K
Faraj
Capital Health Regional Medical Center, Trenton, NJ, USA.
Bipinpreet
B
Nagra
deep venous Thrombosis; paradoxical embolism; patent foramen Ovale; tissue plasminogen activator; transesophageal echocardiogram