Traversing boundaries: thrombus in transit with paradoxical embolism

Area of Science:

• Cardiology
• Neurology
• Vascular Medicine

Background:

• Patent foramen ovale (PFO) is common, yet paradoxical embolism (PDE) is rare, accounting for less than 2% of arterial emboli.
• PDE occurs when a venous thrombus crosses a right-to-left shunt, leading to systemic embolization.
• This case highlights a patient with concurrent deep vein thrombosis, stroke, and arterial emboli, all linked to a PFO.

Observation:

• A 72-year-old male presented with symptoms indicative of multiple thromboembolic events.
• Echocardiography directly visualized a thrombus traversing the patent foramen ovale.
• Transesophageal Echocardiography (TEE) further confirmed the thrombus in transit within the aorta and pulmonary artery.

Findings:

• The study confirms a rare instance of paradoxical embolism.
• Direct visualization of a clot passing through a PFO provides definitive evidence of the embolic source.
• The patient's stroke and arterial emboli were directly attributed to the PFO-mediated paradoxical embolus.

Implications:

• This case underscores the importance of considering PDE in patients with unexplained thromboembolic events and a PFO.
• Direct visualization techniques like echocardiography are crucial for diagnosing rare embolic phenomena.
• Understanding the mechanism of PDE can inform preventative strategies and treatment decisions for affected individuals.