Stroke or cerebrovascular accident is common and is most commonly embolic or haemorrhagic. A common source of embolism is the heart and as such echocardiogram is an essential investigation. However, clinicians need to be aware of rare sources of embolism. We report a rare and interesting case of a 61-year-old Caucasian man who presented with stroke and on evaluation was found to have a large thrombus coiled striding over a patent foreman ovale into the right and left atrium consistent with a 'thrombus in transit'. The origin of the thrombus was later confirmed to be from the left saphenous vein. This case highlights an interesting case of 'thrombus in transit'.
Stroke ; Myxoma ; Foramen Ovale, Patent ; Embolism, Paradoxical

The close relationship between patent foramen ovale(PFO)and cryptogenic ischemic cerebrovascular disease and migraine has been concerned for years. However,in the field of non-cardiac surgery and anesthesiology, PFO and related clinical problems are less recognized. Under perioperative circumstances,PFO may generate many challenges such as paradoxical systematic embolism and severe hypoxemia. This article briefly introduces the epidemiology, paradoxical embolism, and detection methods of PFO and discribes the perioperative complications and corresponding perioperative strategies for prevention and cure.
Embolism, Paradoxical ; Foramen Ovale, Patent ; Humans ; Hypoxia

Patent foramen ovale (PFO) is growing in clinical interest because of a renewed focus on embolic stroke of undetermined source (ESUS), the PFO attributable fraction (the 10-point Risk of Paradoxical Embolism score), technical advances in PFO diagnosis, and the emergence of endovascular device closure as a treatment option. However, recent randomized controlled trials of the management of patients with ESUS and PFO failed to demonstrate the superiority of closure over medical treatment. The mechanisms of stroke other than paradoxical embolism may be important in patients with ESUS and PFO. This paper reviews the current understanding of the pathophysiology of stroke and therapeutic options in patients with PFO and ESUS.
Diagnosis ; Embolism, Paradoxical ; Foramen Ovale, Patent* ; Humans ; Stroke

Embolism, Paradoxical ; complications ; Female ; Humans ; Middle Aged ; Myocardial Infarction ; etiology

Paradoxical embolism refers to the embolic entry of a venous thrombus into the systemic circulation through a right-to-left shunt. Impending paradoxical embolism, in which a venous thrombus extends from the right atrium through a patent foramen ovale (PFO) into the left atrium, is usually diagnosed with echocardiography. The most common cause of paradoxical embolism through a PFO is the acute pulmonary embolism. We report a case of a 78-year-old woman with acute pulmonary embolism, complicated by impending paradoxical embolism.
Aged ; Echocardiography ; Embolism* ; Embolism, Paradoxical ; Female ; Foramen Ovale, Patent ; Heart Atria ; Humans ; Pulmonary Embolism* ; Thrombosis

Precutaneous transcatheter device closure of interatrial communications is used as an alternative to surgery or long-term anticoagulation for the treatment of patients with paradoxical cerebral embolism. We report a case of successful percutaneous transcatheter closure of small atrial septal defect in a 34 year old female patient with acute cerebral infarction presumably caused by paradoxical embolism through the defect.
Cerebral Infarction ; Embolism, Paradoxical ; Female ; Heart Septal Defects, Atrial ; Humans ; Intracranial Embolism

Pulmonary embolism and concomitant right atrial thrombus entrapped in a patent foramen ovale (PFO) is a rare, unusual finding in echocardiography. The diagnosis of paradoxical embolism is usually presumptive when PFO is detected by echocardiography. We herein reported a case of a 53-year-old patient presenting with pulmonary embolism in which a thrombusin-transit through a PFO was found and disappeared during transesophageal echocardiography.
Echocardiography ; Echocardiography, Transesophageal ; Embolism, Paradoxical ; Foramen Ovale, Patent ; Humans ; Middle Aged ; Pulmonary Embolism ; Thrombosis

Adult ; Embolism, Paradoxical ; diagnosis ; therapy ; Humans ; Male ; Pulmonary Embolism ; diagnosis ; therapy

We experienced a patient who developed a cerebral air embolism after subclavian venous catheter removal. The patient underwent gastric antrectomy under impression of gastric cancer. After surgery, right subclavian venous catheter was removed while the patient was kept in supine position for 15 minutes. When he changed to sitting position, he became agitated and O2 saturation was dropped to 72%. Im-mediately 100% O2 was administered via air mask. Computed tomography of brain showed multiple focal air densities in the cerebral vessels. Three days after the event, he slowly regained consciousness with persistent left hemipareis. After rehabilitation, he was able to walk with quadcane and gained functional improvement.
Brain ; Catheters* ; Consciousness ; Dihydroergotamine ; Embolism, Air* ; Embolism, Paradoxical ; Humans ; Masks ; Rehabilitation ; Stomach Neoplasms ; Supine Position

A paradoxical embolism is defined as a systemic arterial embolism requiring the passage of a venous thrombus into the arterial circulatory system through a right-to-left shunt, and is commonly related to patent foramen ovale (PFO). However, coexisting pulmonary embolisms, deep vein thromboses (DVT), and multipe systemic arterial embolisms, associated with PFO, are rare. Here, we report a patient who had a cryptogenic ischemic stroke, associated with PFO, which is complicated with a massive pulmonary thromboembolism, DVT, and renal infarctions, and subsequently, the patient was treated using a thrombolytic therapy.
Embolism ; Embolism, Paradoxical ; Foramen Ovale, Patent ; Humans ; Infarction ; Kidney Diseases ; Pulmonary Embolism ; Renal Artery ; Stroke ; Thrombolytic Therapy ; Thrombosis ; Venous Thrombosis