Paradoxical embolism. A diagnostic challenge and its detection during life

Area of Science:

• Cardiology
• Vascular Surgery

Background:

• Paradoxical embolism involves venous clots traveling to arterial circulation.
• It often presents with unexplained arterial emboli, complicating diagnosis.

Observation:

• Two cases presented with recurrent cerebral, brachial, and coronary embolism, alongside pulmonary embolism.
• Initial cardiac catheterization showed no pulmonary hypertension or intracardiac shunt.

Findings:

• A patent foramen ovale with an interatrial right-to-left shunt was identified using an ascorbate dilution technique during a Valsalva maneuver.
• This demonstrates a subtle shunt not detected by standard methods.

Implications:

• Paradoxical embolism should be considered in arterial embolism cases lacking a clear source, particularly with concurrent venous or pulmonary thrombosis.
• Surgical interruption of the inferior vena cava proved effective in managing these patients.