Paradoxical embolus: an unusual indication for upper limb amputation

Paradoxical emboli occur when venous embolic material passes into the arter ial circulation (via a right-to-left cardiac shunt). The association of par adoxical emboli and arterial ischaemia has been described previously, espec ially with respect to cerebral infarcts.(1,2) We describe a case in which d ouble paradoxical emboli following a long haul flight, resulted in emergenc y amputation of an upper limb. Amputation resulting from a paradoxical embo lus has not previously been described.