The diagnosis of paradoxical embolization typically requires evidence of acute systemic arterial occlusion, systemic venous thrombosis, and a pathway for the thromboembolus to bypass the pulmonary vasculature. However, even when all of these findings are present, they cumulatively represent only a “smoking gun” from which a diagnosis is inferred. It is rare that one captures the actual process of paradoxical embolization “red-handed.”
These transthoracic and transesophageal echocardiographic images demonstrate a thrombus traversing the patent foramen ovale of a 76-year-old woman (Fig 1⇓). She had presented with syncope, and a ventilation-perfusion lung scan revealed a segmental abnormality strongly suggestive of pulmonary embolus. Emergency surgery confirmed the echocardiographic diagnosis and may have saved her the devastation of systemic arterial occlusion. The thrombus that was extricated from the atria and the patent foramen ovale is shown in Fig 2⇓.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Lukes Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to Dr Hugh A. McAllister, Jr, St Luke’s Episcopal Hospital and Heart Institute, 6720 Bertner, MC 4-265, Houston, TX 77030.
- Copyright © 1996 by American Heart Association