This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (50)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Venous Thromboembolism  • Review  • Echocardiography  • Cardiac Diagnostic Tests  • Alert me on articles by topic

Robert R. Meacham III, MD; A. Stacey Headley, MD; Michael S. Bronze, MD; James B. Lewis, MD; Michelle M. Rester, MD

Arch Intern Med. 1998;158:438-448.

The advent of echocardiography has led to the more frequent discovery of impending paradoxical embolism. Paradoxical embolism should be considered whenever there is an arterial embolism from an unidentified source in the presence of a concomitant venous thromboembolic phenomenon. Patients with paradoxical embolism present with neurological abnormalities or features suggesting arterial embolism. Annually, paradoxical embolism may account for up to 47000 strokes in the United States, and a patent foramen ovale has been reported in up to 35% of the normal population. Events that give rise to pulmonary hypertension may result in a right-to-left shunt through a patent foramen ovale allowing a venous thromboembolism access to the arterial circulation. Herein we report a case of impending paradoxical embolism and review the pertinent literature.

From the University of Tennessee-Memphis Lung Research Program and the Divisions of General Internal Medicine (Drs Meacham, Lewis, and Rester), Infectious Disease (Dr Bronze), and Pulmonary and Critical Care Medicine (Dr Headley), Department of Medicine, University of Tennessee and Baptist Memorial Hospital, Memphis.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Cardiogenic and aortogenic brain embolism.
Doufekias et al.
J Am Coll Cardiol 2008;51:1049-1059.
ABSTRACT | FULL TEXT  

Systemic Thrombolysis Using Tissue Plasminogen Activator for a Patient with Paradoxic Embolism: A Case Report
Fan et al.
VASC ENDOVASCULAR SURG 2007;41:136-139.
ABSTRACT  

Successful endovascular treatment of bilateral renal artery paradoxical embolus by a modified standard technique
Goueffic et al.
Nephrol Dial Transplant 2006;21:2315-2317.
FULL TEXT  

Patent foramen ovale and unexplained stroke.
Albin et al.
NEJM 2006;354:1753-1755.
FULL TEXT  

Impending Paradoxical Thromboembolism Associated with Acute Pulmonary Embolism
Takami and Terasawa
Asian Cardiovasc. Thorac. Ann. 2006;14:170-171.
FULL TEXT  

Caught in the act: Serial, real time images of a thrombus traversing from the right to left atrium across a patent foramen ovale
Thanigaraj et al.
Eur J Echocardiogr 2006;7:179-181.
ABSTRACT | FULL TEXT  

Are systemic emboli reduced in computer-assisted knee surgery?: A PROSPECTIVE, RANDOMISED, CLINICAL TRIAL
Kalairajah et al.
J Bone Joint Surg Br 2006;88-B:198-202.
ABSTRACT | FULL TEXT  

Clinical practice. Patent foramen ovale in young adults with unexplained stroke.
Kizer and Devereux
NEJM 2005;353:2361-2372.
FULL TEXT  

Suspected Iatrogenic Paradoxical Embolization in a Cat
Green and Hogan
Journal of the American Animal Hospital Association 2005;41:193-197.
ABSTRACT | FULL TEXT  

Paradoxical Brain Embolism Caused by Pulmonary Arteriovenous Fistula and Coincident Pulmonary Embolism: A Case Report
Miyabe et al.
ANGIOLOGY 2004;55:577-581.
ABSTRACT  

Acute Myocardial Infarction in a Child: Possible Pathogenic Role of Patent Foramen Ovale Associated With Heritable Thrombophilia
Carano et al.
Pediatrics 2004;114:e255-e258.
ABSTRACT | FULL TEXT  

Solid and gaseous cerebral microembolization during off-pump, on-pump, and open cardiac surgery procedures
Abu-Omar et al.
J. Thorac. Cardiovasc. Surg. 2004;127:1759-1765.
ABSTRACT | FULL TEXT  

Etiology of Mental Status Changes in Patients After Total Hip Arthroplasty: Hypoxemia or Paradoxical Embolization of Fat or Bone Marrow?
Daly et al.
JBJS 2003;85:967-967.
FULL TEXT  

Arrested Paradoxical Emboli in Transit Diagnosed by Intraoperative Transesophageal Echocardiography
Avery and MacGillivray
Anesth. Analg. 2002;95:1569-1571.
ABSTRACT | FULL TEXT  

How should patients with patent foramen ovale be managed?
ALP et al.
Heart 2001;85:242-244.
FULL TEXT  

Acute right-to-left inter-atrial shunt; an important cause of profound hypoxia
Marples et al.
Br J Anaesth 2000;85:921-925.
ABSTRACT | FULL TEXT  

A pregnant patient with bilateral ischaemic limbs
Postgrad. Med. J. 2000;76:663b-663.
FULL TEXT  

Septic paradoxical embolus through a patent foramen ovale after pacemaker implantation
Allie et al.
Ann. Thorac. Surg. 2000;69:946-948.
ABSTRACT | FULL TEXT  

Impending Paradoxical Embolism
Cheng and Headley
Arch Intern Med 1998;158:1720-1720.
FULL TEXT