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Thrombus-in-transit and paradoxical embolism
Kul Aggarwal1, Vinod K Jayam, Michael A Meyer
1University Hospital and Clinics, MC 312 Cardiology, University of Missouri Health Sciences Center, One Hospital Drive, Columbia, MO 65212, USA. aggarwalk@health.missouri.edu
Summary
Paradoxical embolism, a rare condition, occurs when a venous clot travels to the arterial system. Diagnosis involves identifying a venous thrombus, arterial embolus, and heart communication, often visualized via transesophageal echocardiogram.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Paradoxical embolism is an uncommon yet significant clinical event.
- Diagnosis requires evidence of venous thrombus, arterial embolus, and intracardiac communication.
- Suspicion is warranted in patients with unexplained systemic arterial emboli.
Observation:
- A case of "thrombus-in-transit" across the interatrial septum is presented.
- The patient had a patent foramen ovale, deep venous thrombosis, and cerebrovascular stroke.
- Transesophageal echocardiography with contrast is a key diagnostic tool.
Findings:
- The study highlights the diagnostic criteria for paradoxical embolism.
- It emphasizes the importance of considering this diagnosis in specific clinical scenarios.
- Imaging confirmed a thrombus traversing a patent foramen ovale.
Implications:
- Early recognition and diagnosis of paradoxical embolism can prevent further embolic events.
- Transesophageal echocardiography is crucial for visualizing intracardiac shunts and thrombi.
- This case underscores the need for a high index of suspicion for paradoxical embolism in patients with cryptogenic stroke and DVT.