Pulmonary and Paradoxical Embolism after Fracture of the Big Toe in a Patient with Patent Foramen Ovale

Abstract

The coexistence of pulmonary and paradoxical embolism is very rare. We report the case of a patient with evidence of both concomitant pulmonary and paradoxical embolism (cerebellar stroke), consequent to left foot immobilization after left big toe fracture. The patent foramen ovale and the increase in right atrium pressure due to pulmonary embolism accounted for the paradoxical embolism.

Atypical manifestations of pulmonary embolism

“…However, in another study among 113 consecutive patients (mean age 62) with suspected cardiogenic embolic stroke and patent foramen ovale (PFO), CTPA identi ied only 4 patients with PE [91]. An analysis of 12 anecdotal reports of PE-related PDE [92][93][94][95][96][97][98][99][100][101][102][103][104][105] reveals three patterns of clinical presentation (Table 4), namely, simultaneous occurrence of typical PE symptoms(or hypoxaemia) and symptoms of PDE, occurrence of PE symptoms followed by occurrence of stroke a day or so later, and occurrence of stroke without any documentation of breathlessness. In the latter category were four patients [102][103][104][105] in whom PDE-related stroke occurred in a PE patient who had reported neither breathlessness, chest pain or cough.…”

Incomplete endothelialization of WatchmanTM Device: Predictors and Implications from Two Cases

“…The most common intracardiac defect associated with PDE is the patent foramen ovale (PFO) defect with a venous embolus that crosses the PFO to the systemic circulation. [3][4][5][6] Patients with PFO are usually asymptomatic. However, if RA pressure increases, a right to left shunt occurs with risk for PDE.…”

“…The Brain arteries are the most frequent localization of PDE. [6] However, embolization may happen in any other systemic (not systematic) arteries.…”

“…[3] The simultaneous occurrence of PE and PDE is rare. [4,5,6] Here we present a case of PE and PDE after EPS and RFCA of the slow pathway in a patient with recurrent SVT due to atrioventricular nodal reentry tachycardia (AVNRT). To our knowledge, such a case of PE and PDE has not been reported after SVT ablation.…”