Management of straddling thrombus through patent foramen ovale complicating pulmonary embolism

2021 ◽  
Vol 14 (4) ◽  
pp. e240957
Author(s):  
Vijeth Bhat ◽  
Stuart lane ◽  
Sam Orde
Keyword(s):  
Pulmonary Embolism ◽  
Patent Foramen Ovale ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Rare Condition ◽  
Bleeding Risk ◽  
Paradoxical Embolism ◽  
Foramen Ovale ◽  
Haemodynamic Stability ◽  
Surgical Thrombectomy

A 60-year-old man was admitted to intensive care unit with the diagnosis of pulmonary embolism. Bedside transthoracic echocardiography revealed the extension of the thrombus into left atrium and ventricle through patent foramen ovale (PFO). A straddling thrombus also described as impending paradoxical embolism is a rare condition when thrombus embolised to the heart gets caught in PFO. Morbidity is extremely high in case of systemic embolisation. Due to rarity, the treatment options are mainly individualised and no guidelines exist. There are few treatment strategies described in literature from surgical to interventional radiology to conservative approach. Treatment strategy should take individual parameters such as patient’s age, haemodynamic stability, bleeding risk and comorbidities into consideration. Our patient successfully underwent emergency surgical thrombectomy.

Paradoxical Arterial Embolism Involving Both Upper Extremities in a Patient With Pulmonary Embolism and a Patent Foramen Ovale

2010 ◽  
Vol 17 (6) ◽  
pp. E98-E101 ◽  
Author(s):  
O. S. Kouskov ◽  
D. J. Nichols ◽  
D. J. O’Hearn
Keyword(s):  
Pulmonary Embolism ◽  
Patent Foramen Ovale ◽  
Treatment Options ◽  
Paradoxical Embolism ◽  
The Body ◽  
Upper Extremities ◽  
Foramen Ovale ◽  
Arterial Embolism ◽  
Clinical Presentations ◽  
Significant Disability

Paradoxical embolization is an uncommon but devastating complication of pulmonary embolism (PE). Awareness of this complication with prompt recognition and treatment could serve to preclude significant disability and death. Described is a case of PE associated with paradoxical embolism to the arteries of both upper extremities. While patent foramen ovale (PFO) is common, paradoxical embolism is infrequent but can involve almost any artery of the body. Discussed are the risk factors, clinical presentations, and diagnostic and treatment options for paradoxical embolism. Awareness of the potential for paradoxical embolization in patients with PE is essential to its prompt recognition and treatment.

scholarly journals Pulmonary Embolism in Ischemic Stroke

2018 ◽  
Vol 45 (3) ◽  
pp. 343-345
Author(s):  
Prasanna Venkatesan Eswaradass ◽  
Sadanand Dey ◽  
Dilip Singh ◽  
Michael D. Hill
Keyword(s):  
Pulmonary Embolism ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Aortic Arch ◽  
Patent Foramen Ovale ◽  
Pulmonary Arteries ◽  
Paradoxical Embolism ◽  
Ct Scans ◽  
Foramen Ovale ◽  
Ct Angiogram

AbstractSilent pulmonary embolism (PE) may be associated with acute ischemic stroke (AIS). We identified 10 patients from 3,132 unique patients (3,431 CT scans). We retrospectively examined CT angiogram of patients with AIS to determine the frequency of concurrent PE in AIS. The period prevalence of PE was 0.32. Seven patients had concurrent PE, whereas three had PE diagnosed 2 days after their AIS presentation. We suspected paradoxical embolism via patent foramen ovale as the cause of stroke in three patients and thrombophilia in four patients. Seven patients had poor outcome including four deaths. CT angiogram stroke protocol images from aortic arch to vertex allows visualization of upper pulmonary arteries and PE detection in AIS.

scholarly journals Simultaneous Massive Pulmonary Embolism and Impending Paradoxical Embolism Through a Patent Foramen Ovale

2009 ◽  
Vol 53 (15) ◽  
pp. 1338 ◽  
Author(s):  
Vernon Mascarenhas ◽  
Arun Kalyanasundaram ◽  
Louis Andrew Nassef ◽  
Serrie Lico ◽  
Anwer Qureshi
Keyword(s):  
Pulmonary Embolism ◽  
Patent Foramen Ovale ◽  
Massive Pulmonary Embolism ◽  
Paradoxical Embolism ◽  
Foramen Ovale

scholarly journals Acute Pulmonary Embolism and Paradoxical Embolism in Patients with Patent Foramen Ovale: to Close or Not to Close…That is the Question!

2017 ◽  
Vol 11 ◽  
Author(s):  
Marco Zuin ◽  
Gianluca Rigatelli
Keyword(s):  
Pulmonary Embolism ◽  
Patent Foramen Ovale ◽  
Acute Pulmonary Embolism ◽  
Randomized Trials ◽  
Paradoxical Embolism ◽  
Foramen Ovale ◽  
International Guidelines ◽  
Acute Pe

<p>Nowadays, the treatment of patent foramen ovale (PFO) after acute pulmonary embolism (PE) remains matter of speculation. Absence of both randomized trials and recommendations in current international guidelines complicate the decisions making in such patients. In the present manuscript we discuss about the reasons for which PFO should be closed after acute PE.</p>

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