CTICasesParadoxical systemic embolism via patent foramen ovale
Imaging findings
Chest CT demonstrates a large pulmonary embolism with severe right heart strain and a markedly dilated right atrium. A serpiginous, worm-like filling defect is visible in the aorta, having crossed from the right atrium to the left atrium through a patent foramen ovale due to reversed, right-to-left flow.
Key takeaways
Severe right heart strain from a massive pulmonary embolism can elevate right atrial pressure, causing a reversal of flow through a patent foramen ovale. This allows a venous thrombus to cross into the systemic circulation, causing paradoxical arterial embolism and systemic organ infarction.
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