HOMEPRODUCTSCOMPANYCONTACTFAQResearchDictionaryPharmaSign Up FREE or Login

Impending paradoxical embolism presenting as a pulmonary embolism, transient ischemic attack, and myocardial infarction.

Abstract
A 25-year-old man presented with complaints of nonpleuritic, substernal chest pain, dyspnea, and decreasing exercise tolerance. His vital signs were normal, with the exception of an oxygen saturation level of 93% while breathing room air. During his assessment, he developed transient left facial droop, left arm and leg weakness, and an ataxic gait, which lasted 15 min then resolved spontaneously. Cardiac enzyme levels were elevated, and an ECG revealed T-wave inversion in leads III, aVF, V1, and V2 with evolving ST-segment elevation in leads V3 through V5. The findings of a CT scan and MRI of the head were negative; a Doppler ultrasound of the right lower extremity revealed a thrombus extending from the common femoral vein to the popliteal vein. Cardiac catheterization revealed no evidence of epicardial coronary artery disease. CT pulmonary angiography revealed bilateral pulmonary emboli. Transesophageal echocardiography (TEE) showed a 4-cm, dumbbell-shaped mass lodged in a patent foramen ovale, confirming the diagnosis of an impending paradoxical embolism. The patient was started on therapy with unfractionated heparin, and his thrombus resolved spontaneously by hospital day 5. An impending paradoxical embolism is rare but should be suspected in anyone presenting with evidence of both venous and arterial emboli. The therapeutic options include anticoagulation, thrombolysis, and surgical embolectomy. We would propose that initial treatment with anticoagulation therapy and following with serial TEEs may be appropriate therapy in an otherwise stable patient, with surgical embolectomy or thrombolysis reserved for the treatment of thrombi that do not resolve with anticoagulation therapy or for patients with clinical deterioration.
AuthorsScott L Willis, Timothy S Welch, John P Scally, Michael W Bartoszek, Lance E Sullenberger, Jeremy C Pamplin, Oleh W Hnatiuk
JournalChest (Chest) Vol. 132 Issue 4 Pg. 1358-60 (Oct 2007) ISSN: 0012-3692 [Print] United States
PMID17934122 (Publication Type: Case Reports, Journal Article)
Topics
  • Adult
  • Echocardiography, Transesophageal
  • Embolism, Paradoxical (complications, diagnosis, diagnostic imaging)
  • Heart Atria (diagnostic imaging)
  • Heart Diseases (diagnostic imaging)
  • Humans
  • Ischemic Attack, Transient (etiology)
  • Male
  • Myocardial Infarction (etiology)
  • Pulmonary Embolism (diagnostic imaging, etiology)
  • Radiography
  • Thrombosis (diagnostic imaging)
  • Venous Thrombosis (diagnostic imaging)

Join CureHunter, for free Research Interface BASIC access!

Take advantage of free CureHunter research engine access to explore the best drug and treatment options for any disease. Find out why thousands of doctors, pharma researchers and patient activists around the world use CureHunter every day.
Realize the full power of the drug-disease research graph!


Choose Username:
Email:
Password:
Verify Password:
Enter Code Shown: