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J Thorac Cardiovasc Surg 2008;136:527-528
© 2008 The American Association for Thoracic Surgery

Brief Communication

Life-threatening impending paradoxical embolus caught "red-handed": Successful management by multidisciplinary team approach

Cliff K. Choong, MD, MBBS, FRCS, FRACSa,b,*, Patrick A. Calverta, Florian Faltera, Raj Mathurc, Derek Appletond, Francis C. Wellsa, Peter M. Schofielda, Robin Crawfordc

a Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
b Department of Surgery, University of Cambridge, Cambridge, United Kingdom
c Department of Gynaecology, The Rosie Hospital NHS Trust, Cambridge, United Kingdom
d Department of Radiology, Addenbrooke's Hospital NHS Trust, Cambridge, United Kingdom

Received for publication September 3, 2007; accepted for publication October 19, 2007.

* Address for reprints: Cliff K. Choong, MD, MBBS, FRCS, FRACS, University Lecturer, University of Cambridge, Consultant Cardiothoracic Surgeon, Papworth Hospital NHS Foundation Trust, Cambridge, CB23 8RE, United Kingdom. (Email: cliffchoong@hotmail.com).

The first 20% of the full text of this article appears below.

Life-threatening impending paradoxical embolus is rare. We describe a case that was caught "red-handed" and successfully treated by a multidisciplinary team approach.

Clinical Summary

A 47-year-old woman presented with dyspnea and syncope. Before the presentation, she had been bed bound for 1 week after an ankle injury. During assessment, she had signs of respiratory distress but was hemodynamically stable. Blood analysis was unremarkable except for a significantly increased D-dimer. She was treated empirically with heparin for pulmonary embolism. Computed tomographic pulmonary angiography (CTPA) of the chest revealed extensive emboli in both main pulmonary arteries with filling defects in the left and right atria (Figures E1–E3). She was transferred to a tertiary cardiothoracic center. Echocardiography revealed a 9-cm–long mobile mass within the right atrium traversing through a patent foramen ovale (PFO) into the left atrium (Go Figure 1, A). Whole-body computed tomography revealed an unexpected finding of a 23 x 13 x 12-cm giant uterine fibroid compressing both iliac veins with extensive thrombi in the right iliac and lower limb . . . [Full Text of this Article]




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