Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access
Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc
Journal website https://www.cardiologyres.org

Case Report

Volume 5, Number 3-4, August 2014, pages 112-117

Paradoxical Thromboembolism/ST-Elevation Myocardial Infarction via a Patent Foramen Ovale in Sub-Massive Pulmonary Embolism Following an Upper Extremity Deep Venous Thrombosis: Is It Time for a Change in the Standard of Care?

Figures

Figure 1.
Figure 1. (A) CT angiogram of head and neck demonstrating the right internal jugular vein thrombus. (B) Baseline EKG in normal sinus rhythm no ST-T changes. (C) Transthoracic ECHO 4-chamber view of the heart with no thrombus during first hospitalization. (D) CT PE protocol revealing emboli in right and left PAs (arrows). (E) Transthoracic ECHO 4-chamber view of the heart revealing thrombus in the LV cavity extending across the mitral valve with point of origin in the LA (arrow). (F) EKG demonstrating ST elevation in II, III and aVF.
Figure 2.
Figure 2. Transesophageal ECHO. (A) Serpiginous thrombus in the LA. (B) Thrombus straddling across the PFO (broad arrow). (C) Color Doppler demonstrating flow across the inter-atrial septum via the PFO (broad arrow). (D) Embolus in the PA (arrow).
Figure 3.
Figure 3. Paradoxical thromboembolism. (A) CT angiogram of lower extremities with emboli (filling defects; dotted circle) in the right illio-femoral arteries. (B) CT angiogram of upper extremities with emboli (filling defects; dotted circle) in the right subclavian artery. Cardiac catheterization, (C) left coronary artery; (D) right coronary artery.