Ned Tijdschr Geneeskd. 2026 Apr 15;170:D8798.
ABSTRACT
A patent foramen ovale (PFO) is present in approximately 25-30% of adults and is usually asymptomatic. However, under conditions of elevated right heart pressure, a PFO can enable right-to-left shunting, allowing venous thrombi to enter the arterial circulation: a mechanism known as paradoxical embolism. We present a case of a 51-year-old woman who developed dyspnea, abdominal pain and, a painful swollen leg. Imaging revealed a saddle pulmonary embolism, renal and splenic infarctions and occlusion of the right brachial artery. Echocardiography confirmed the presence of a PFO. Other common sites of paradoxical embolism include the brain, mesenteric circulation, and coronary arteries. In patients with venous thrombosis, clinicians should carefully assess for signs of concomitant arterial embolism: examine the abdomen, evaluate peripheral pulses in the limbs and perform a basic neurological examination. This case highlights the importance of thorough clinical evaluation to ensure timely recognition of this potentially serious condition.
PMID:41989121