THORACIC AORTIC DISSECTION THAT WASNT - CT DEMONSTRATION OF PROBABLE PARADOXICAL EMBOLUS SECONDARY TO UNSUSPECTED PULMONARY EMBOLUS

A patient presented with chest pain, cyanosis and acute ischaemia of t he left arm. Aortic dissection was considered to be the likely diagnos is. CT demonstrated multiple large pulmonary emboli and a serpiginous thrombus occluding the origin of the left subclavian artery. Venous th rombosis was proven. The sudden onset of cyanosis followed immediately by a systemic arterial embolus with morphology typical of a venous so urce was very likely the result of transforaminal shunting induced by massive pulmonary emboli. Post-mortem studies have demonstrated a high incidence of asymptomatic patent foramen ovale in normal individuals. Using contrast echocardiography techniques, any physiological or path ological rise in right heart pressure increases the likelihood of righ t to left transforaminal shunting of blood or embolic material.