Paradoxical embolism with thrombus stuck in a patent foramen ovale: A review of treatment strategies

A. Mirijello, M. M. D'Errico, S. Curci, P. Spatuzza, D. Graziano, M. La Viola, V. D'Alessandro, M. Grilli, G. Vendemiale, M. Cassese, S. De Cosmo

Research output: Contribution to journalReview article

Abstract

OBJECTIVE: Paradoxical embolism represents a rare condition occurring when a thrombus originating from venous system produces pulmonary embolism and systemic embolization through an intracardiac or pulmonary shunt. The evidence of a thrombus entrapped in a patent foramen ovale (PFO) is an even more rare condition. There is uncertainty about the optimal treatment strategy. PATIENTS AND METHODS: A 58-year-old male patient was admitted to our Internal Medicine Unit with the diagnosis of bilateral bronchopneumonia. During hospitalization, the co-occurrence of chest pain and amaurosis led us to hypothesize a paradoxical embolism. RESULTS: Transthoracic echocardiography showed the presence of a thrombus stuck over the interatrial septum. A contrast-enhanced chest CT scan showed multiple pulmonary embolisms and brain CT scan documented a hypodense area, of ischemic significance, in the left occipital lobe near tentorium. In order to prevent further embolization, emergency cardiac surgery (right atriotomy, removal of thrombus and closure of the PFO, pulmonary thrombectomy) was performed without complications. CONCLUSIONS: Although rare, the evidence of a thrombus stuck in a patent foramen ovale represents a clinical emergency. The optimal therapeutic approach is still debated. The surgical correction seems to be a safe and effective option for these patients.

Original languageEnglish
Pages (from-to)8885-8890
Number of pages6
JournalEuropean Review for Medical and Pharmacological Sciences
Volume22
Issue number24
Publication statusPublished - Jan 1 2018

Keywords

  • Embolism
  • Patent foramen ovale
  • Pulmonary embolism
  • Stroke
  • Thrombosis

ASJC Scopus subject areas

  • Pharmacology (medical)

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    Mirijello, A., D'Errico, M. M., Curci, S., Spatuzza, P., Graziano, D., La Viola, M., D'Alessandro, V., Grilli, M., Vendemiale, G., Cassese, M., & De Cosmo, S. (2018). Paradoxical embolism with thrombus stuck in a patent foramen ovale: A review of treatment strategies. European Review for Medical and Pharmacological Sciences, 22(24), 8885-8890.