case_images: PMC10870038_01
case_images: Contrast-enhanced computed tomography and pulmonary CT angiography. (A) Abdominal contrast-enhanced computed tomography (CT) revealed bilateral renal infarctions (yellow arrowhead). (B) Pulmonary CT angiography revealed bilateral pulmonary embolisms (yellow arrowhead).
case_images: cureus-0016-00000052535-i01.jpg
case_images: PMC10870038_01_cureus-0016-00000052535-i01.jpg
case_images: FIG1
case_images: Contrast-enhanced CT of the abdomen revealed bilateral renal infarctions without dissection of the renal arteries (Figure 1A). We suspected PE with paradoxical embolism and performed a pulmonary CT angiography and a lower extremity venous CT angiography, which showed thrombi in the bilateral main pulmonary arteries (Figure 1B), deep vein thrombosis at the left femoral vein, RVT (Figure 2B), and contrast agent flow from the right atrium to the left atrium, suggesting a shunt through a PFO (Figure 2C).
case_images: Cardiac imaging. (A) Point-of-care ultrasound showed a mobile right ventricular thrombus (RVT) with a length of 15 mm. (B) Chest contrast-enhanced computed tomography (CT) revealed multiple RVT (yellow arrowhead). (C) Chest contrast-enhanced CT revealed contrast agent flow from the right atrium to the left atrium, suggesting a shunt through a patent foramen ovale (PFO) (yellow arrowhead). (D) Transthoracic echocardiography showed multiple bubbles in the left atrium and ventricle through the PFO.
case_images: cureus-0016-00000052535-i02.jpg
case_images: PMC10870038_01_cureus-0016-00000052535-i02.jpg
case_images: FIG2
case_images: Point-of-care ultrasound was performed to investigate the etiologies of renal infarctions and hypoxia, and it showed right ventricular dilation, right ventricular strain, tricuspid regurgitant pressure gradient above 50 mmHg, and a mobile thrombus at the apex of the right ventricle (Figure 2A). We suspected PE with paradoxical embolism and performed a pulmonary CT angiography and a lower extremity venous CT angiography, which showed thrombi in the bilateral main pulmonary arteries (Figure 1B), deep vein thrombosis at the left femoral vein, RVT (Figure 2B), and contrast agent flow from the right atrium to the left atrium, suggesting a shunt through a PFO (Figure 2C). In addition, a micro-bubble study on TTE was positive during the Valsalva maneuver (Figure 2D).