Paradoxical embolism causing acute embolic events in a patient with hereditary thrombophilia

Paradoxical embolism (PDE) is an uncommon but clinically important entity. In clinical practice, PDE involving multiple organs is a rarely reported occurrence. Herein, we present a case of acute pulmonary embolism complicated by PDE through an atrial septal defect (ASD) causing a series of embolic events. Subsequent laboratory screening confirmed the patient to be a heterozygous carrier of the factor V Leiden mutation that increases the risk for deep venous thrombosis (DVT). The patient was treated with warfarin indefinitely and underwent transcatheter ASD closure and implantation of an inferior vena cava filter.