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Case Reports
. 2021 Feb 23:63:102188.
doi: 10.1016/j.amsu.2021.102188. eCollection 2021 Mar.

Patent foramen oval: A rare case of acute ischemia of the upper limb: A case with 2 year follow-up

O Kallel  1 , D Charmake  1 , I Chergui  1 , N El Ouafi  1   2 , N Ismaili  1   2
Affiliations
Case Reports

Patent foramen oval: A rare case of acute ischemia of the upper limb: A case with 2 year follow-up

O Kallel et al. Ann Med Surg (Lond). .

Abstract

Introduction and importance: Paradoxical emboli (PDE) represent less than 2% of all arterial emboli, that is why they are considered as a rare event. We notice that the upper limb ischemia is very exceptional as part of a paradoxical embolism. This case presentation can help in considering the diagnosis the PFO as one of the most important risk factors of paradoxical embolism.

Case presentation: Here, we present a rare case of a 69-year-old woman with paradoxical systemic arterial embolism, presented by an acute ischemia of the upper limb, secondary to deep venous thrombosis and pulmonary embolism in the presence of patent foramen ovale, treated with long-term anticoagulation with rivaroxiban 20 mg/day, because of the mutation of the Factor II whish indicate already the anticoagulation.

Discussion: Echocardiographic techniques such as transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), or transcranial echocardiography (TCE) are the principal tools used to detect PFO. There are no clear consensus on the treatment of PDE. Presenting symptoms largely depend upon the location of the embolus, necessitating a different approach for each patient, but There is essentially three therapeutic options: surgical embolectomy, thrombolysis, and anticoagulation.

Conclusion: PFO closure is, today, a standardized and safe intervention, but the indication stay individualized to each patient.

Keywords: Paradoxical embolism; Patent foramen oval; Pulmonary embolism; Upper limb ischemia; case report.

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Conflict of interest statement

There are no conflicts.

Figures

Fig. 1
Fig. 1
Thoracic computed tomography before any treatment. the two main pulmonary artery are enlarged.
Fig. 2
Fig. 2
Transoesophageal echocardiography demonstrated an ASIA.
Fig. 3
Fig. 3
Transoesophageal echocardiography demonstrated positive bubble test.
See this image and copyright information in PMC

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