CTICasesAcute Pulmonary Embolism with Paradoxical Embolus to the Celiac Artery
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Imaging findings
Contrast-enhanced chest CT demonstrates extensive, acute bilateral pulmonary emboli and signs of right ventricular strain, including dilatation of the right ventricle and atrium. High-resolution images confirm the presence of a patent foramen ovale. Slices extending into the upper abdomen reveal an acute filling defect within the celiac artery, representing a systemic paradoxical embolus.
Key takeaways
In patients with acute pulmonary embolism, elevated right heart pressures can cause a pre-existing patent foramen ovale to open or shunt right-to-left, allowing venous thromboemboli to cross into the systemic circulation. This can cause unexpected arterial ischemia, such as celiac or mesenteric ischemia, even in patients who are otherwise asymptomatic from an abdominal standpoint.
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