Paradoxical embolism: a rare life- and limb-threatening emergency

ABSTRACT This article presents a case of a 43-year-old man with paradoxical embolism. The patient had simultaneous deep venous thrombosis, pulmonary embolism and bilateral limb-threatening arterial occlusions. The unifying diagnosis was paradoxical embolism through a previously undetected atrial septal defect. Suggestions for the evaluation and emergency management of paradoxical embolism are outlined, and the literature is briefly reviewed.

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Antiphospholipid syndrome leading to paradoxical embolus and stroke via secundum atrial septal defect

BMJ Case Reports ◽

10.1136/bcr-2020-239674 ◽

2021 ◽

Vol 14 (3) ◽

pp. e239674

Author(s):

Amy Campbell ◽

Avinash Kumar Kanodia ◽

Christopher Robert Gingles ◽

Harinath Chandrashekar

Keyword(s):

Risk Assessment ◽

Pulmonary Embolism ◽

Case Report ◽

Atrial Septal Defect ◽

Antiphospholipid Syndrome ◽

Septal Defect ◽

Paradoxical Embolism ◽

Secundum Atrial Septal Defect ◽

Paradoxical Embolus ◽

Risk Assessment And Management

We have presented a case of a 22-year-old man, presenting with cerebral infarct, subsequently found to have antiphospholipid syndrome (APS), deep venous thrombosis, pulmonary embolism and atrial septal defect (ASD), thereby confirming the presence of infarct due to paradoxical embolism in this patient. The importance of ASD in the patients of APS, resulting in paradoxical embolism is debatable, with recent studies undermining its importance. We have demonstrated that it does indeed happen. This would have implications in the risk assessment and management of ASD in such patients. This case report is intended to serve as a reminder of this association and the need to perform further research in this area.

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Methylenetetrahydrofolate reductase polymorphism in a case with atrial septal defect, deep venous thrombosis, thromboembolism and recurrent spontaneous abortion

Turkish Journal of Thoracic and Cardiovascular Surgery ◽

10.5606/tgkdc.dergisi.2012.177 ◽

2012 ◽

Vol 20 (4) ◽

pp. 907-909

Author(s):

Adem Güler

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Atrial Septal Defect ◽

Spontaneous Abortion ◽

Septal Defect ◽

Methylenetetrahydrofolate Reductase ◽

Recurrent Spontaneous Abortion

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Caught in the Act: Impending Paradoxical Embolism

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230201000415 ◽

2002 ◽

Vol 10 (4) ◽

pp. 342-343 ◽

Cited By ~ 8

Author(s):

Alex M Fabricius ◽

Martin Krüger ◽

Michaela Hanke ◽

Friedrich W Mohr

Keyword(s):

Pulmonary Embolism ◽

Atrial Septal Defect ◽

Transesophageal Echocardiography ◽

Patent Foramen Ovale ◽

Septal Defect ◽

Paradoxical Embolism ◽

Foramen Ovale ◽

Recurrent Pulmonary Embolism ◽

Systemic Anticoagulation ◽

Residual Thrombus

In a 73-year-old woman admitted with pulmonary embolism, a thrombus wedged across a patent foramen ovale was revealed by transesophageal echocardiography. After systemic anticoagulation, cardiac embolectomy and closure of the atrial septal defect were considered. Before surgery, repeat transesophageal echocardiography revealed only a small patent foramen ovale with no residual thrombus. We assumed dissolution of the thrombus as the patient had no sign of systemic or recurrent pulmonary embolism.

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Perforation of inferior vena cava during filter placement

VASA ◽

10.1024/0301-1526/a000087 ◽

2011 ◽

Vol 40 (2) ◽

pp. 157-162 ◽

Cited By ~ 6

Author(s):

Piecuch ◽

Wiewiora ◽

Nowowiejska-Wiewiora ◽

Szkodzinski ◽

Polonski

Keyword(s):

Pulmonary Embolism ◽

Inferior Vena Cava ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Inferior Vena ◽

Vena Cava ◽

Retroperitoneal Hematoma ◽

Ivc Filter ◽

Filter Placement ◽

Therapeutic Method

The placement of an inferior vena cava (IVC) filter is a therapeutic method for selected patients with deep venous thrombosis and pulmonary embolism. However, insertion and placement of the filter may be associated with certain complications. For instance, retroperitoneal hematoma resulting from perforation of the wall by the filter is such a very rare but serious complication. We report the case of a 64-year-old woman with perforation of the IVC wall and consecutive hematoma caused by the filter who was treated surgically.

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High Antibody Levels to Prothrombin Imply a Risk of Deep Venous Thrombosis and Pulmonary Embolism in Middle-aged Men

Thrombosis and Haemostasis ◽

10.1055/s-0038-1657711 ◽

1997 ◽

Vol 78 (04) ◽

pp. 1178-1182 ◽

Cited By ~ 59

Author(s):

Timo Palosuo ◽

Jarmo Virtamo ◽

Jari Haukka ◽

Philip R Taylor ◽

Kimmo Aho ◽

...

Keyword(s):

Pulmonary Embolism ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Plasma Proteins ◽

Alpha Tocopherol ◽

Index Number ◽

Thromboembolic Events ◽

Middle Aged ◽

Phospholipid Binding ◽

Antiprothrombin Antibodies

SummaryAntibodies against phospholipid-binding plasma proteins, such as β2-glycoprotein I (β2-GPI) and prothrombin, are associated with thromboembolic events in patients with systemic lupus erythematosus and also in subjects with no evident underlying diseases. We wanted to examine whether increased levels of antibodies to negatively-charged phospholipids (cardiolipin), to phospholipid-binding plasma proteins β2-GPI and prothrombin and to oxidised low-density lipoprotein (LDL) were associated with risk of deep venous thrombosis or pulmonary embolism in subjects with no previous thrombosis. The antibodies were measured in stored serum samples from 265 cases of deep venous thrombosis of the lower extremity or pulmonary embolism occurring during a median follow-up of about 7 years and from 265 individually matched controls. The study subjects were middle-aged men participating in a cancer prevention trial of alpha-tocopherol and beta-carotene and the cases of thromboembolic events were identified from nationwide Hospital Discharge Register.The risk for thrombotic events was significantly increased only in relation to antiprothrombin antibodies. As adjusted for body mass index, number of daily cigarettes and history of chronic bronchitis, myocardial infarction and heart failure at baseline, the odds ratio per one unit of antibody was 6.56 (95% confidence interval 1.73-25.0). The seven highest individual optical density-unit values of antiprothrombin antibodies were all confined to subjects with thromboembolic episodes.In conclusion, the present nested case-control study showed that high autoantibody levels against prothrombin implied a risk of deep venous thrombosis and pulmonary embolism and could be involved in the development of the thrombotic processes.

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