A case of impending paradoxical embolism

Impending paradoxical embolism (IPDE) is a rare condition characterized by the presence of a thrombus in a patent foramen ovale. We were able to image a thrombus lodged in a patent foramen ovale and remove the thrombus before it could result in arterial embolism.

A 24-year-old woman was admitted to our hospital with chest pain and dyspnea. Pulmonary embolism was diagnosed via computed tomography. Additionally, transesophageal echocardiography revealed a thrombus lodged in a patent foramen ovale and fluttering in both atria, leading to a diagnosis of IPDE. Rather than incurring the risk associated with embolization by thrombolytic treatment, we elected to remove the incarcerated thrombus and close the patent foramen ovale under cardiopulmonary bypass.

We successfully treated a case of IPDE by removing the thrombus under cardiopulmonary bypass, before arterial thrombosis could occur.