Saddle Pulmonary Embolus and Simultaneous Common Carotid and Subclavian Artery Emboli

Area of Science:

• Cardiology
• Vascular Medicine
• Medical Diagnostics

Background:

• Patent foramen ovale (PFO) is a common cardiac anomaly, present in 27-35% of the population.
• Right-to-left cardiac shunts associated with PFO can allow venous thromboemboli to cross into the arterial circulation.
• Paradoxical emboli are a rare but serious complication, particularly in patients with a history of deep venous thrombosis (DVT).

Observation:

• A 45-year-old male with hypercoagulability and a history of DVT presented with symptoms of chest pain, dyspnea, and left arm numbness.
• Imaging revealed a massive pulmonary embolus (PE) and emboli in the aortic arch, left common carotid, and left subclavian arteries.
• Echocardiography confirmed a right-to-left intracardiac shunt, indicative of a PFO.

Findings:

• The patient underwent successful endovascular and open thrombectomy for the pulmonary artery embolism.
• The arterial emboli were attributed to a paradoxical embolism originating from the DVT.
• The presence of a PFO was confirmed as the likely source of the right-to-left shunt facilitating the paradoxical embolism.

Implications:

• This case underscores the critical need to consider paradoxical emboli in patients presenting with arterial thromboembolism and concurrent venous thromboembolism, especially those with known or suspected intracardiac shunts.
• Early diagnosis and evaluation for PFO in such patients are crucial for implementing appropriate preventative strategies.
• Prompt identification and management of PFO can significantly reduce the risk of recurrent embolic events and improve patient outcomes.