Fatal paradoxical emboli captured in transit through a paten
The following case has been reported in the European Heart Journal Case Reports. A 73-year-old male patient with history of hypertension presented to the hospital with altered mental status, right facial droop, and bilateral leg swelling. His last known normal (LKN) time was unclear. Patient was homeless with no prior documented medical conditions, no prior history of stroke or coagulopathy.

CT of his brain on presentation was concerning for left hyperdense middle cerebral artery sign; subsequent computed tomography angiography of his head confirmed occlusion of the M1 segment of the left middle cerebral artery. An ultrasound of the lower extremities showed a thrombus in the femoral and popliteal veins bilaterally. Arterial Doppler ultrasound revealed diminished flow in the bilateral femoral arteries with no flow in the popliteal arteries.

A transthoracic echocardiogram revealed an echogenic density in the right atrium extending into the left atrium and left ventricle across the mitral valve via a patent foramen ovale (PFO). The findings were suggestive of an embolus in transit through a PFO.

Patient was anticoagulated with unfractionated heparin. Endovascular embolectomy was attempted but unsuccessful. He was not a candidate for thrombolysis given unclear LKN in the context of stroke. He passed away with multiorgan ischaemia after a complicated hospital course.

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