IMPENDING PARADOXICAL EMBOLISM THROUGH A PATENT FORAMEN OVALE IN AN OCTOGENARIAN WITH PULMONARY-EMBOLISM - DETECTION BY TRANSESOPHAGEAL ECHOCARDIOGRAPHY AND SUCCESSFUL TREATMENT BY ANTICOAGULATION

Paradoxical embolism through a patent foramen ovale (PFO), an increasi ngly recognized cause of cryptogenic stroke and peripheral embolism, i s believed to play little role in the elderly, mainly based on retrosp ective studies on selected populations. Paradoxical embolism is mostly a presumptive diagnosis, while definite demonstration of a thrombus c rossing a PFO is rare. We describe the case of an 84-year-old patient with pulmonary embolism in whom a thrombus in transit through a PFO wa s found by transesophageal echocardiography (TEE). Treatment with anti coagulants allowed thrombus resolution without evidence of further emb olic events. This finding demonstrates that (impending) paradoxical em bolism may be present in the 'oldest old'. Its prompt diagnosis may al low effective treatment even with medical therapy alone. We suggest th at paradoxical embolism may be not so rare in the elderly. The apparen t decline in prevalence with age may be the result of less extensive d iagnostic assessment in the elderly, as compared to younger patients. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.