SESSION TITLE: Monday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Paradoxical embolism (PDE) refers to an embolus of venous origin which is carried directly into the arterial circulation, or vice versa through an arteriovenous shunt such as a patent foramen ovale (PFO). PFO is usually asymptomatic; however, it may play a role in the development of a cryptogenic stroke (CS). About one-third of the cryptogenic strokes may be associated with a PFO. PDE has a diverse clinical presentation and the nature and complications of this pathology can be potentially life-threatening. CASE PRESENTATION: A 68-year-old female with a medical history of hypertension was admitted with complaints of acute visual disturbances, manifested as partial hemianopia without headache. On physical examination, she had no neurological dysfunction. Heart sounds were normal. A computed tomography (CT) scan of the brain showed a 7mm hyperdensity in the left cerebellar area. Tissue plasminogen activator was not given due to uncertainty about the time of onset of the symptoms. The patient was started on aspirin and atorvastatin. The next day, the patient had a sudden onset of hypoxia, with an oxygen saturation of 80%, as well as a left-sided facial droop and left-sided motor weakness. D-dimers were high, at 17,900 μg/ L (NL <500, ng/mL). CT angiography (CTA) of chest revealed a saddle pulmonary embolus. Agitated saline contrast exam showed significant right to left shunting across the interatrial septum, which was mobile, but appeared to be structurally intact, with only a small PFO. Subacute infarcts were seen in the right occipital-parietal area posteriorly on CT brain. She was anticoagulated with intravenous unfractionated heparin and was subsequently transitioned to argatroban. While recovering, the patient developed an acute abdomen. CT angiography revealed a nearly occlusive thrombus in the superior mesenteric artery that required embolectomy and small bowel resection. After recovery from bowel surgery, the patient underwent a planned percutaneous closure of PFO. The PFO was closed with a #28 Amplatzer septal occluder device. DISCUSSION: Simultaneous multifocal systemic embolization across a PFO is not a common occurrence. However, when multiple sites of systemic embolization occur, paradoxical embolization across a PFO should be strongly suspected. Evaluation of the interatrial septum with transesophageal echocardiography can identify several high risk features for recurrent paradoxical embolism CONCLUSIONS: Closure of PFO should be employed as a long term solution to prevent recurrence of stroke and other forms of paradoxical systemic embolization in selected patients with high risk features of the interatrial septum. Reference #1: Rakhit RD (November 2003). "Case 2: Patent foramen ovale (PFO) and paradoxical embolism". Heart. 89 (11): 1362. https://doi.org/10.1136/heart.89.11.1362. PMC 1767929. PMID 18069145. DISCLOSURES: No relevant relationships by Malik Ahmad, source=Web Response No relevant relationships by Taha Ahmed, source=Web Response No relevant relationships by Joanna Ghobrial, source=Web Response No relevant relationships by HASSAN MEHMOOD LAK, source=Web Response No relevant relationships by Anjli Maroo, source=Web Response