Semper aliquid haeret: A paradoxical embolus lodged in patent foramen ovale

摘要

A case of a 54 year old man with unknown medical history suddenly collapsing with cardiac arrest. Post mortem MRI (PMMR) revealed T1 hyperintense material in the pulmonary trunk, a soft tissue edema of the right lower limb, a T2-hyperintense area in the myocardial septum and a patent foramen ovale (PFO). These imaging findings were confirmed by autopsy, which additionally showed a deep vein thrombosis with consecutive central pulmonary embolism and subacute myocardial ischemia. Autopsy showed also a thrombosis of the of the Left Anterior Descending Artery (LAD). PMMR was able to show thrombotic material lodged in the PFO in situ, which was not depictable in autopsy. The combination of the findings of PMMR and autopsy revealed a massive central pulmonary embolism with a paradoxical embolism through a PFO and consecutive coronary thrombosis.