Objective: To present two cases of paradoxical embolism.
Clinical features: A 78-year-old woman presented to a hospital emergency department, seven weeks after a right total hip replacement, with chest tightness and sudden-onset left arm and leg pain and paraesthesia. Scanning showed multiple pulmonary emboli, right iliofemoral vein thrombosis, left popliteal and axillary artery embolism, a patent foramen ovale and a right to left shunt. A 41-year-old woman, with a 10-year history of Sjögren's syndrome, presented with sudden-onset left foot pain. Scanning showed emboli in the popliteal and profunda femoris arteries of the left leg, thrombosis involving the right deep calf veins, popliteal vein and superficial femoral vein, and a patent foramen ovale. Based on these critical findings, a diagnosis of paradoxical embolism was made in each case.
Intervention and outcome: Both patients required arterial embolectomy. After commencement of anticoagulant therapy there were no further episodes of embolism.
Conclusions: Paradoxical embolism is an important syndrome which requires a high degree of clinical suspicion as well as several specific investigations for prompt diagnosis.