Pulmonary embolism and abdominal pain in a young patient: A case report of a rare clinical entity

A 20-year-old man with reduced mobility, from a car accident, presented to the Emergency Department of our hospital due to progressive dyspnea and heart palpitations the lasted three days. A bedside cardiac ultrasound and a Computed Tomography Pulmonary Angiogram (CTPA) were immediately performed, revealing strain of the right ventricle and pulmonary embolism (PE). The patient subsequently complained about abdominal pain and a Computed Tomography of the Abdominal Aorta (CTAO) revealed arterial embolism in the renal and splenic circulations, along with the right common femoral artery. Phlebography of inferior limbs exhibited deep vein thrombosis in the left popliteal vein. A percutaneous suction thrombectomy had been performed successfully. The patient underwent a transesophageal echocardiography with agitated saline test that revealed a patent foramen ovale (PFO), a diagnosis which explained the paradoxical embolism in both arterial and venous circulations. Paradoxical embolism is quite uncommon and should not be ignored in cases with indications of arterial embolism after PE.