A rare case of paradoxical embolism
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A 61-year-old male patient with no previous medical history presented to our hospital complaining of rapidly progressive dyspnoea over 2 days, no orthopnoea, no paroxysmal nocturnal dyspnoea, no chest pain. Heart and chest examinations were unremarkable and tender right calf muscles was evident on lower limb examination. Laboratory work-up showed elevated D-dimer and leucocytosis, urgent duplex of both lower limbs showed extensive fresh deep venous thrombosis (DVT), urgent multi-slice computed tomography (MSCT) of the pulmonary arteries showed extensive bilateral pulmonary thrombo-embolization of both right and left main branches. Transthoracic echocardiography revealed good left ventricular systolic function, right ventricular strain with signs of acute pulmonary embolism, and evidence of small inter-atrial septal defect with intermittent color flow in both directions.Intravenous agitated saline was injected through the central venous line several times till evidence of right to left shunt through an atrial septal defect or patent foramen ovale (PFO) was detected.....

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