Paradoxical embolization. Case report and review of the literature

A 32-year-old morbidly obese woman had bilateral subclavian artery embolism. After embolectomy, a right heart catheterization showed a patent foramen ovale and a right-to-left shunt. Pulmonary angiography revealed multiple pulmonary emboli. Bilateral lower extremity venography demonstrated left ileofemoral thrombi as the probable source. The patient was successfully treated with an inferior vena caval umbrella and anticoagulant drugs.