Cunha Roberto, Silva Manuel, Henrique Alberto, Maximiano Pedro, Correia Mafalda, Vieira Isabel, Cássio Isabel, Oliveira Nelson, Dias Emanuel
Angiology and Vascular Surgery Department, Hospital do Divino Espírito Santo (HDES), Ponta Delgada, São Miguel Island, Azores, Portugal.
J Surg Case Rep. 2023 Jul 27;2023(7):rjad435. doi: 10.1093/jscr/rjad435. eCollection 2023 Jul.
Paradoxical embolism is a rare cause of arterial embolism, even more those resulting in acute ischemia of the upper limb. A case of a 45-year-old patient with acute paradoxical upper limb embolization and acute limb ischemia is presented. A review of the most recent evidence on the diagnosis and management of paradoxical embolism were explored. The cardiac defect most associated with paradoxical embolism is a patent foramen oval. The diagnosis can be performed by transthoracic or transesophageal echocardiography. Closure of the foramen oval is a safe and effective procedure; however, there is no clear consensus on when it should be performed, so the strategy should be individualized. A high level of suspicion of paradoxical embolism should exist in the presence of simultaneous venous and arterial embolism. The investigation of the embolic source is fundamental to avoid the recurrence of events.
