Cine angiographic diagnosis of patent foramen ovale in paradoxical embolism,

Paradoxical embolism. An underrecognized problem

Despite reports of the clinical presentations and devastating consequences of paradoxical embolus (PDE) for more than a century, this diagnosis continues to be frequently missed. Because the prevalence of patent foramen ovale (PFO) is 27 to 35% in the normal population and the presence of deep vein thrombosis or pulmonary embolus may not be clinically obvious, a high suspicion for PDE is needed in the event of unexplained arterial occlusion. While contrast echocardiography and transcranial Doppler ultrasound have facilitated clinical recognition of PDE, the optimum approach to diagnosis requires clarification. Primary therapy for patients with PDE is anticoagulation, with thrombolytics considered in carefully selected individuals, but there is little published information regarding long-term treatment and outcomes. Prevention remains essential whenever possible. It is not yet defined whether prophylactic treatment of persons with recognized predispositions to PDE (eg, PFO and pulmonary hypertension) is beneficial.

Paradoxical embolism after amputation in a newly diagnosed diabetic

Paradoxical embolism is rare, but it should be considered in cases of (1) postoperative arterial or cerebral embolism, (2) pulmonary embolism accompanied by systemic arterial or cerebral embolism, (3) systemic arterial or cerebral embolism in patients with a known right-to-left shunt or pulmonary arteriovenous malformation, and (4) systemic or cerebral embolism when no cardiac source can be found. Prognosis depends on both the extent of embolization and the clinical condition of the patient before and during treatment.