Multiple paradoxical embolisms caused by central venous catheter thrombus passing through a patent foramen ovale: A case report

Figure 1 Coronary angiography. A: Emergent coronary angiography (CAG) revealed a total occlusion in the proximal segment of the right coronary artery (RCA); B: CAG revealed no significant atherosclerotic lesions in the left main, left anterior descending and left circumflex; C: After percutaneous coronary intervention (PCI), repeat angiography revealed the result of thrombolysis in myocardial infarction (TIMI) 3 blood flow in RCA. Thrombus were observed in the first posterior descending artery and posterior lateral artery; D: Two months after PCI, CAG showed TIMI 3 blood flow in the distal region of the RCA without signs of thrombus.

Figure 2 Imaging examination of central venous catheter associated thrombosis and patent foramen ovale. A: Doppler ultrasound of the right internal jugular vein showing a large thrombus (18 mm × 15 mm × 13 mm) at the tip of the central venous catheter; B: Transthoracic echocardiogram showing a suspicious patent foramen ovale (PFO); C: In resting conditions, transesophageal echocardiography (TEE) with saline contrast showing no evidence of a right-to-left shunt; D: TEE following saline contrast clearly demonstrates the presence of bubbles in the left atrium, with Valsalva indicating the presence of a moderate right-to-left shunt at the atrial level through a PFO. RA: Right atrium; LA: Left atrium.