Paradoxical embolism - Report of a case involving four organ systems

Paradoxical embolism through a patent foramen ovale (PFO) can involve multi ple organs simultaneously. The most commonly involved sites are the cerebru m and the extremities. Paradoxical embolism to coronary arteries or upper e xtremities is relatively uncommon. We report a case of acute pulmonary embo lism and paradoxical embolism through a patent foramen ovale involving the left upper extremity, brain, and coronary artery. Early diagnosis in the em ergency department was made by a trans-esophageal echocardiogram, and the p atient was successfully treated with intravenous t-PA and heparin, Patients with acute pulmonary embolism or deep venous thrombosis who also develop s igns of systemic embolism should be evaluated for a patent foramen ovale, ( C) 2000 Elsevier Science Inc.