Paradoxical Peripheral Embolism – a Rare and Underestimated Event

Abstract 

We present a case of paradoxical peripheral embolism related to a patent foramen ovale (PFO) in a young female with clinical signs of pulmonary embolism and simultaneous left hand acute ischaemia. A PFO associated with a right-to-left pressure gradient was revealed by trans-oesophageal echocardiography. She underwent a successful bilateral brachial thrombo-embolectomy with cerebral protection by clamping of the right common carotid and simultaneous proximal right common carotid thrombo-embolectomy, according to prior angiographic study. Paradoxical embolism is still rarely considered as a possible cause of acute limb ischaemia and may be underestimated.

Keywords: Paradoxical embolism, Patent foramen ovale, Acute ischaemia