Pulmonary embolism complicated by impending paradoxical embolism – a case report and a review of literature

Abstract

Pulmonary embolism (PE) is a common CV emergency that may lead to acute life-threatening right ventricular failure. Right-sided heart thrombi are relatively rare (4-18% of patients presenting with acute PE). The presence of right heart thrombi, particularly when mobile, is associated with a significantly increased risk of mortality. Thrombus straddling the patent foramen ovale (TSFO) in PE is even rarer and it is at high risk of impending paradoxical embolism (PDE). We report a case of a PE complicated by a right-sided heart thrombus and impending PDE and we analysed different therapeutic options.