Coexistence of pulmonary embolism and systemic arterial embolism suggest the diagnosis of paradoxical embolism which suggests the presence of intracardiac defects such as patent foramen ovale (PFO).
A 42 year old man was found to have a paradoxical embolism in the systemic arterial circulation, in the setting of pulmonary embolism and deep vein thrombosis (DVT) in the lower extremities.
Paradoxical embolism and intracardiac shunt should be immediately considered in a patient with pulmonary embolism and systemic arterial embolism. Diagnostic modalities included arteriogram and saline contrast echocardiography. Closure of intracardiac shunt is needed for patients who are at risk for recurrent embolic events./>/>
Coexistence of pulmonary embolism and systemic arterial embolism indicates the presence of paradoxical embolism, which suggests a diagnosis of an intracardiac defect. The most common intracardiac defect associated with paradoxical embolism is patent foramen ovale (PFO), which has been described in 25├óÔé¼ÔÇ£30 percent of individuals 1. Most patients with a patent foramen ovale (PFO) remain asymptomatic. Under normal physiological conditions, patent foramen ovale (PFO) allows a small amount of L-R shunt without causing significant hemodynamic change. However, in the setting of increased right atrial pressure, significant right to left shunt can occur and lead to paradoxical embolism. The most important potential clinical manifestation due to a paradoxical embolism is ischemic stroke. There have been few reports of paradoxical emboli in systemic circulation coexistent with PE, deep vein thrombosis (DVT) and hypercoagulable state.
The most frequently cited criteria for the diagnosis of paradoxical embolism are:1). Embolism in arterial system that is not originated from left heart or from the arterial system itself. 2). Abnormal communication between the arterial and venous systems as evidenced by imaging tests. 3). Presence of venous thrombosis or embolism in the form of deep vein thrombosis or pulmonary embolism. 4). Increased right sided pressure which contributes right to left shunting, be it transient or longstanding 2./>
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