Serpentine Thrombus Traversing the Foramen Ovale: Paradoxical Embolism Shown by Transesophageal Echocardiography
Authors: Sandra I. Barbour
Journal: Annals of Internal Medicine (1996)

Brief Communications15 July 1996Serpentine Thrombus Traversing the Foramen Ovale: Paradoxical Embolism Shown by Transesophageal EchocardiographySandra I. Barbour, MD, Keith F. Izban, MD, Cesar V. Reyes, MD, Thomas L. McKiernan, MD, and Eric K. Louie, MDSandra I. Barbour, MDFrom Loyola University Medical Center, Maywood, Illinois., Keith F. Izban, MDFrom Loyola University Medical Center, Maywood, Illinois., Cesar V. Reyes, MDFrom Loyola University Medical Center, Maywood, Illinois., Thomas L. McKiernan, MDFrom Loyola University Medical Center, Maywood, Illinois., and Eric K. Louie, MDFrom Loyola University Medical Center, Maywood, Illinois.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-125-2-199607150-00006 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Paradoxical embolism is a rare cause of myocardial infarction. We describe a patient in whom morbid obesity obscured clinical examination and rendered invasive diagnostic evaluation by angiography unfeasible. Transesophageal echocardiography showed the pathophysiologic basis for respiratory decompensation (pulmonary thromboembolism) and myocardial infarction (paradoxical embolism to a coronary artery) after transthoracic echocardiography and computed axial tomography had failed to distinguish among the initial differential diagnostic possibilities. These possibilities included left ventricular systolic dysfunction, pulmonary embolism, pulmonary sepsis, and acute decompensation of chronic pulmonary disease caused by morbid obesity.Case ReportA 48-year-old man presented with progressive dyspnea and no history of ...References1. Hust MH, Staiger M, Braun B. Migration of paradoxic embolus through a patent foramen ovale diagnosed by echocardiography: successful thrombolysis. Am Heart J. 1995; 129:620-2. Google Scholar2. 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Pressure and volume loading of the right ventricle have opposite effects on left ventricular ejection fraction. Circulation. 1995; 92:819-24. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Loyola University Medical Center, Maywood, Illinois.Corresponding Author: Eric K. Louie, MD, Division of Cardiology, Loyola University Medical Center, Building 110, Room 6228, 2160 South First Avenue, Maywood, IL 60153.Current Author Addresses: Dr. Barbour: The Permanente Medical Group, Inc., Department of Cardiology, 2025 Morse Avenue, Sacramento, CA 95825-2115. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byCaught in the middle: Thrombus-in-transit through patent foramen ovaleThrombus-in-transit: Two Cases and a Review of Diagnosis and ManagementMassive Pulmonary Embolism Complicated by a Patent Foramen Ovale with Straddling Thrombus: Report of a CaseInstant percutaneous closure of patent foramen ovale in patients with acute myocardial infarction and normal coronary arteriesParadoxical embolism to the left main coronary artery: Visualization by transesophageal echocardiographyAcute pulmonary embolism with a serpentine thrombus in the right atrium traversing the foramen ovaleBrain EmbolismThe Role of Transesophageal Echocardiography in the Diagnosis and Treatment of Right Atrial ThrombiDiagnosis and management of entrapped embolus through a patent foramen ovale 15 July 1996Volume 125, Issue 2Page: 111-113KeywordsBlood pressureEchocardiographyHeartInterleukinsMyocardial infarctionPatient advocacyPulmonary embolismPulmonary hypertensionThoraxThrombosis Issue Published: 15 July 1996 Copyright & PermissionsCopyright © 1996 by American College of Physicians. 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