Paradoxical embolism, deep vein thrombosis, pulmonary embolism in a patient with patent foramen ovale: a case report

Guo, Shuang; Missri, José

doi:10.1186/1752-1947-1-104

Cited by 23 publications

(15 citation statements)

References 4 publications

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“…The mechanism of the renal infarction in our case was considered that transiently increased right arterial hypertension, due to acute pulmonary embolism induced continuous opening of PFO and permitted a passage of the thrombi in deep vein into the arterial system 11). It should also be noted that though there have been several case reports of systemic PDEs with PTE associated with PFO,7)8)13) cases of non-cerebral, systemic PDEs, associated with PFO, are relatively lower than for cerebral PDEs. One report showed that only 2.9% of patients with PFO presented with a presumptive diagnosis of systemic embolism,14) though when patients with major pulmonary embolism have PFO, the incidence of peripheral artery embolisms, can significantly be increased (up to 15%) 15)…”

Section: Discussionmentioning

confidence: 70%

A Case of Cryptogenic Stroke Associated with Patent Foramen Ovale Coexisting with Pulmonary Embolisms, Deep Vein Thromboses, and Renal Artery Infarctions

Park

Yun

et al. 2012

Korean Circ J

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A paradoxical embolism is defined as a systemic arterial embolism requiring the passage of a venous thrombus into the arterial circulatory system through a right-to-left shunt, and is commonly related to patent foramen ovale (PFO). However, coexisting pulmonary embolisms, deep vein thromboses (DVT), and multipe systemic arterial embolisms, associated with PFO, are rare. Here, we report a patient who had a cryptogenic ischemic stroke, associated with PFO, which is complicated with a massive pulmonary thromboembolism, DVT, and renal infarctions, and subsequently, the patient was treated using a thrombolytic therapy.

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Section: Discussionmentioning

confidence: 70%

A Case of Cryptogenic Stroke Associated with Patent Foramen Ovale Coexisting with Pulmonary Embolisms, Deep Vein Thromboses, and Renal Artery Infarctions

Park

Yun

et al. 2012

Korean Circ J

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“…This predisposed him to the development of lower extremity deep vein thrombosis and large bilateral PE [ 1 ]. The development of arterial embolus to the left arm was made possible by a large PFO and has been cited several times in the literature [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

PFO closure in high-risk patient with paradoxical arterial embolism, deep vein thrombosis, pulmonary embolism and factor V Leiden genetic mutation

Parikh

Vacek

2018

Oxford Medical Case Reports

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Occurrence of paradoxical arterial embolism may cause the first symptoms in patients with a coexisting hypercoagulable state and patent foramen ovale (PFO). This can result in significant morbidity and mortality depending on the location of the embolism. The risks and benefits of closure of small PFOs have not been well elucidated in prior studies. We describe a patient with a history of Factor V Leiden heterozygosity who presented with left arm pain secondary to arterial embolism. The patient was a 51-year-old male who initially presented to the emergency department after awaking from sleep with progressive, severe, burning left arm pain. He had also noted intermittent shortness of breath over the 2 weeks prior to admission. Temperature was 97.4 F, pulse 86, respiratory rate 20 and blood pressure 121/87. Oxygen saturation was 94% on supplemental oxygen. He had a cool left upper extremity and the patient described subjective paresthesias in this extremity. Left radial pulse was difficult to palpate. Physical exam was otherwise unremarkable. Troponin I was mildly elevated at 0.217 ng/l. White blood cell count was 11.8 and INR 1.1. EKG showed sinus tachycardia with non-specific T abnormalities in the anterior leads. His past medical history was notable for only hypertension and hyperlipidemia. Current recommendation is for antiplatelet or anticoagulation for those with hypercoaguable states who suffer a stroke; there is currently no absolute indication for closure device. We describe the case of a 51-year-old male who had presented with left arm pain and shortness of breath. The computed tomography (CT) angiography of chest showed pulmonary emboli with heavy clot burden bilaterally. Heparin was started, but patient was found to have occlusion along large arteries of the left arm. Emergent left axillary, brachial, radial and ulnar embolectomy for acute critical arm ischemia were performed. The transthoracic echocardiogram done the next day with bubble study was positive for patent foramen ovale. Hypercoaguability showed factor V Leiden heterozygosity. Decision was made for the patient to initiate long-term anticoagulation with rivaroxaban and closure was performed. Patient was advised that closure is off label but opted to proceed with closure in light of hypercoaguable state.

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“…The risk factors associated with embolic recurrence include atrial septal aneurysm, high shunting volume, and shunting at rest. Other risk factors include large PFO (more than 3.4 mm), higher mobility of the PFO valve, a well developed Eustachian valve, a Valsalva maneuver immediately prior to event, and a history of recurrent embolic events [13] . Bissessor et al reviewed 70 percutaneous PFO procedures prospectively.…”

Section: Discussionmentioning

confidence: 99%

Renal infarction caused by paradoxical embolism through a patent foramen ovale

Jeong

Lee

Joung

et al. 2012

Kidney Research and Clinical Practice

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A 48-year-old man presented with acute right flank pain. A computed tomography scan revealed right renal infarction. Because he had no thrombosis in the renal vessels and no clear embolic source, a further examination was performed to find the cause of the renal infarction. On transesophageal echocardiography, a right-to-left shunt during the Valsalva maneuver established a diagnosis of patent foramen ovale. This is a case of paradoxical embolism through a PFO leading to renal infarction.

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Paradoxical embolism, deep vein thrombosis, pulmonary embolism in a patient with patent foramen ovale: a case report

Cited by 23 publications

References 4 publications

A Case of Cryptogenic Stroke Associated with Patent Foramen Ovale Coexisting with Pulmonary Embolisms, Deep Vein Thromboses, and Renal Artery Infarctions

A Case of Cryptogenic Stroke Associated with Patent Foramen Ovale Coexisting with Pulmonary Embolisms, Deep Vein Thromboses, and Renal Artery Infarctions

PFO closure in high-risk patient with paradoxical arterial embolism, deep vein thrombosis, pulmonary embolism and factor V Leiden genetic mutation

Renal infarction caused by paradoxical embolism through a patent foramen ovale

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