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The simultaneous occurrence of deep vein thrombosis and pulmonary and arterial embolization.

Dixon T, Panda M, Desbiens N

Department of Medicine, University of Tennessee College of Medicine-Chattanooga Unit, 975 East Third St., Box 94, Chattanooga, TN 37403, USA. dixont2004@yahoo.com

INTRODUCTION: A 45-year-old female presented with 8 hours of right lower extremity pain and dyspnea. She was tachycardic and her right lower extremity was dusky, cold, and pulseless. DISCUSSION: Computerized tomography of the venous and arterial systems revealed massive pulmonary embolism and right lower extremity arterial and left lower extremity venous thromboses. Management included intra-arterial thrombolytics, right lower extremity arterial embolectomy, and anticoagulation. Echocardiogram revealed a patent foramen ovale (PFO) with a right-to-left shunt. CONCLUSION: We hypothesize that our patient developed deep venous thrombosis that led to major pulmonary embolization and increased right-sided pressures. In the setting of a patent foramen ovale, a later venous embolus transversed the PFO and lodged in the femoral artery. Our case illustrates the importance of a high index of suspicion for a paradoxical embolus in patients with arterial thrombosis.

Published 5 June 2007 in J Gen Intern Med, 22(7): 1040-1.
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