Neither Here nor There: Impending Paradoxical Embolism

      The challenges inherent in the diagnosis and management of a rare condition were clearly illustrated after a 35-year-old man was admitted to the hospital with ominous symptoms. He first detected a problem when he got up to use the bathroom during the previous night and had trouble balancing. This difficulty persisted when he woke up in the morning, and it was now compounded by double vision, left-sided weakness, and left facial droop. When questioned, he also reported new-onset dyspnea on exertion of 3-4 weeks' duration. The patient was morbidly obese and had a history of gout. His current drug therapy consisted of prednisone, allopurinol, and colchicine. He had quit smoking 1 month earlier.
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        • Myers P.O.
        • Bounameaux H.
        • Panos A.
        • Lerch R.
        • Kalangos A.
        Impending paradoxical embolism: systematic review of prognostic factors and treatment.
        Chest. 2010; 137: 164-170
        • Ghent F.
        • Bassin L.
        • Keller M.
        • Cranney G.
        • McKenzie D.
        • Grant P.
        Impending paradoxical embolism: Have we lost the clot?.
        Clin Respir J. 2014; 8: 460-462
        • Nellessen U.
        • Daniel W.G.
        • Matheis G.
        • Oelert H.
        • Depping K.
        • Lichtlen P.R.
        Impending paradoxical embolism from atrial thrombus: correct diagnosis by transesophageal echocardiography and prevention by surgery.
        J Am Coll Cardiol. 1985; 5: 1002-1004
        • Fauveau E.
        • Cohen A.
        • Bonnet N.
        • Gacem K.
        • Lardoux H.
        Surgical or medical treatment for thrombus straddling the patent foramen ovale: impending paradoxical embolism? Report of four clinical cases and literature review.
        Arch Cardiovasc Dis. 2008; 101: 637-644
        • Dietz D.M.
        • Cleveland J.D.
        • Chewning K.G.
        • Dent J.M.
        • Kern J.A.
        • Keeley E.C.
        Impending paradoxical embolism presenting as myocardial infarction.
        J Cardiol Cases. 2013; 7: e145-e148
        • Turfan M.
        • Vatankulu M.A.
        • Murat S.N.
        • Oksuz F.
        • Duran M.
        • Ornek E.
        Thrombolytic treatment of simultaneous pulmonary embolism and impending paradoxical embolism through a patent foramen ovale: a different thrombolytic regimen.
        Heart, Lung Circ. 2012; 21: 225-228
        • Citro R.
        • Panza A.
        • Bottiglieri G.
        • et al.
        Surgical treatment of impending paradoxical embolization associated with pulmonary embolism in a patient with heterozygosis of factor V Leiden.
        J Cardiovasc Med (Hagerstown). 2013; 14: 745-747
        • Faustino A.
        • Costa G.
        • Providência R.
        • Paiva L.
        Impending paradoxical embolism with a thrombus crossing a patent foramen ovale.
        BMJ Case Rep. 2012; : 2012