Istituto di Fisiologia Clinica     
Palinkas A., Marosi G., Csanady M., Picano E. Impending paradoxic embolism resolved by intravenous heparin administration. In: American Journal of Medicine, vol. 111 (07) pp. 581 - 583. elsevier, 2001.
A 49-year-old woman underwent surgery for a varicose vein in her left lower leg. The surgery was uneventful, but 6 days later general convulsions developed and she was in a comatose cerebral state. On admission to the intensive care unit, her signs and symptoms were compatible with right hemispheric cerebrovascular insult. Physical examination of the cardiac, pulmonary, and abdominal systems was unremarkable. A chest radiograph, carotid ultrasonogram, and electrocardiogram all yielded normal results, as did laboratory tests. A computed tomography scan of the brain showed ischemic lesions in the right internal capsule and left hemisphere of the cerebellum. Transesophageal echocardiography (TEE) showed a long, worm-shaped thrombus, extending from the right atrium through the right ventricle, up to the level of the pulmonary valve (Figures 1 and 2). A 4-cm segment of the thrombus passing through the patent foramen ovale was visible in the left atrium and was moving rapidly (Figure 1). Venous duplex examination of the left lower extremity revealed a small thrombus in the short residual stub of the strangulated saphenous vein.
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