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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.

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