Abstract
Impending paradoxical embolism (IPE) also described in the literature as thrombus straddling a patent foramen ovale (PFO) or paradoxical embolus in transit is a rare condition when thrombus (originating mostly in deep veins of lower extremities) embolized to the heart gets caught in PFO or in atrial septal defect without systemic embolization. We present a case of a 39-year-old female on oral contraceptive pills who presented to the emergency department with chief complaint of dyspnea and chest pain. She was found to have saddle pulmonary embolus (PE) extending through PFO to left atrium and into the left ventricle. Patient underwent emergent open pulmonary embolectomy, removal of right and left atrial thrombi, and closure of patent foramen ovale. She tolerated the surgery well and was discharged home on chronic anticoagulation therapy.
Highlights
Impending paradoxical embolism (IPE) described in the literature as thrombus straddling a patent foramen ovale (PFO) or paradoxical embolus in transit is a rare condition when thrombus embolized to the heart gets caught in PFO or in atrial septal defect without systemic embolization
In the setting pulmonary artery pressure elevation often occurs with massive and large pulmonary embolus (PE) that gradient reverses and the clot can migrate through PFO to left atrium causing paradoxical systemic embolization, or a clot that is larger than PFO can be trapped in PFO causing IPE [4]
We present a case of a 39-year-old female who was found to have IPE
Summary
Impending paradoxical embolism (IPE) described in the literature as thrombus straddling a patent foramen ovale (PFO) or paradoxical embolus in transit is a rare condition when thrombus (originating mostly in deep veins of lower extremities) embolized to the heart gets caught in PFO or in atrial septal defect without systemic embolization. More than century later in 1985 Nellessen first described IPE using echocardiography [2]. Because of left to right pressure gradient there is shunt between left and right atrium. In the setting pulmonary artery pressure elevation often occurs with massive and large PE that gradient reverses and the clot can migrate through PFO to left atrium causing paradoxical systemic embolization, or a clot that is larger than PFO can be trapped in PFO causing IPE [4]. We present a case of a 39-year-old female who was found to have IPE. She subsequently underwent surgical thrombectomy with excellent outcome
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