Paradoxical embolism. Diagnosis during life

Abstract

Of 128 reported cases of paradoxical embolism, only twelve have been diagnosed during life. However, five cases of paradoxical embolism have been detected during life at this hospital in two years. These five cases are presented to illustrate the pathophysiologic features that allow detection of paradoxical embolism during life. All five patients had unexplained arterial embolism. None had associated atrial fibrillation, mitral stenosis or myocardial infarction. Each had venous thrombosis. Two patients had congenital heart disease, whereas in three the defect permitting paradoxical embolism was a patent foramen ovale. Each patient was treated to prevent further embolism. Three did well and were discharged. Two died, and at postmortem examination, the clinical diagnosis was confirmed. The detection of five cases in two years indicates that this treatable cause of systemic embolism is substantially more frequent than indicated by the literature. © 1972.