Caretta Giorgio, Robba Debora, Bonadei Ivano, Teli Melissa, Fontanella Benedetta, Vizzardi Enrico, Farina Davide, Raddino Riccardo, Cas Livio Dei
Department of Cardiology, University of Brescia, Piazzale Spedali Civili 1, 25124, Italy.
Cases J. 2009 Sep 17;2:8358. doi: 10.4076/1757-1626-2-8358.
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. It is a relatively rare phenomenon, representing about 2% of all cases of arterial embolism. We report a case of a 79-years-old woman admitted to hospital because of dyspnea and lower left limb pain. CT scan revealed multiple thrombi to kidney, lower limb and superior mesenteric artery during acute pulmonary embolism. Echocardiogram documented a patent foramen ovale with a right-to-left shunt. The patient was treated with thrombolytic therapy and heparin with progressive improvement of symptoms and resolution of pulmonary embolism and peripheral thrombosis. Patent foramen ovale closure was not performed because a life-long anticoagulation therapy was necessary, a tunnel-type patent foramen ovale may increases difficulty in realizing device implantation and there are no clear evidence-based guidelines to date addressing treatment in presence of a patent foramen ovale.
反常栓塞被定义为一种全身性动脉栓塞，需要静脉血栓通过右向左分流进入动脉循环系统。这是一种相对罕见的现象，约占所有动脉栓塞病例的2%。我们报告一例79岁女性因呼吸困难和左下肢疼痛入院。CT扫描显示急性肺栓塞期间肾脏、下肢和肠系膜上动脉有多个血栓。超声心动图记录了卵圆孔未闭伴右向左分流。患者接受了溶栓治疗和肝素治疗，症状逐渐改善，肺栓塞和外周血栓形成得到缓解。未进行卵圆孔未闭封堵，因为需要终身抗凝治疗，隧道型卵圆孔未闭可能会增加器械植入的难度，而且迄今为止尚无明确的循证指南指导卵圆孔未闭的治疗。
