Objective: We present a case of a 48 years-old male, with no cardiovascular risk factors, normal BMI who was hospitalized for altered general condition, progressively lower effort dyspnea, subfebrility in the last 2 weeks. He received recentely antibiotics for interstitial pneumonia
Methods: Clinic exam: altered general condition, afebrile, pale skin and mucous membranes, no adeno-pathy, BP=120/80mmHg, 110/min, regular rhythm, no valvular murmurs or pulmonary rales, hepatomegaly, turgid jugular veins, no signs of deep vein thrombosis (DVT), oxygen saturation 90%. Biological: normochromic normocytic anemia, nitrogen retention, positive D-dimers, neutrophilia, leukocytosis, thrombocyto-penia, negative cTnI. ECG: sinus tachycardia, pattern for pulmonary embolism (PE). Thoracic X-ray rule out pneumonia. Echocardiography: RV and RA dilatation, moderate pulmonary hypertension, a hypoecogen, mo-bile structure, inclavated through interatrial septum, ascending through atrioventricular valves
Results: Diagnosis suspicion: PE complicated with fla-red thrombus inclavated through interatrial septum with mobile extremities protruding through atrioven-tricular valves into systole. The CT scan confirms bila-teral PE, splenic and renal infarction. Etiological suspi-cions of PE: peripheral DVT, neoplasia, thrombophilia. Echocardiographic diagnostic questions of the pre-sence of intracardiac thrombus in left and right cavities: interatrial communication, patent foramen ovale (POF)- congenital vs acquired subsequently increased pressure in the right cavities. The patient received con-tinuous I.V. anticoagulation treatment and the cardi-ac thrombus disappeared, his clinical and paraclinical evolution was favorable
Conclusions: The completion of the investigations es-tablished the positive diagnosis: Bilateral PE. Parado-xical embolism (splenic, renal). Right inferior member DVT. Therapeutic indication at discharge continued anticoagulant treatment and surgical closure of POF (under paradoxical embolism)