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Systemic and venous thromboembolism: think about paradoxical embolism
Monique Cachia1, Michael Pace Bardon1, Peter Fsadni1
1Department of Medicine, Mater Dei Hospital, Msida, Malta.
BMJ Case Reports
|July 30, 2015
Summary
Patent foramen ovale (PFO), a common condition, can lead to paradoxical embolism. This case highlights the importance of considering PFO in patients with both venous and arterial clots.
Area of Science:
- Cardiology
- Vascular Medicine
- Embolism Pathophysiology
Background:
- Patent foramen ovale (PFO) affects 25-30% of the population and is a significant cause of paradoxical embolism.
- PFO is often asymptomatic, with diagnosis typically occurring incidentally during echocardiography.
- Paradoxical embolism occurs when a venous clot crosses into the arterial circulation, often via a PFO.
Observation:
- A middle-aged smoker presented with deep vein thrombosis (DVT) and pulmonary embolism (PE).
- During hospitalization, the patient developed acute upper limb ischemia.
- This clinical course suggested a potential embolic event from the venous system to the arterial system.
Findings:
- The patient's presentation with concomitant venous and arterial thromboembolic events raised suspicion for paradoxical embolism.
- Detailed patient history and physical examination were crucial in identifying the potential underlying cause.
- The case underscores that seemingly unrelated embolic events can share a common etiology.
Implications:
- Clinicians must maintain a high index of suspicion for paradoxical embolism in patients with unexplained arterial events, especially those with risk factors for venous thromboembolism.
- Thorough diagnostic workup, including evaluation for intracardiac shunts like PFO, is essential in managing complex thromboembolic cases.
- Early consideration of PFO can lead to timely diagnosis and appropriate management, potentially preventing further embolic complications.
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