Forensic Science, Medicine and Pathology

, Volume 15, Issue 1, pp 147–150 | Cite as

Entrapped paradoxical thromboembolism

  • Roger W. ByardEmail author
Images in Forensics


A 67-year-old obese woman (BMI 38.3) was found at autopsy to have deep venous thrombosis of the left calf with bilateral peripheral and saddle pulmonary thromboemboli and a 165 mm long segment of paradoxical thromboembolus wedged between the right and left atria through a patent foramen ovale. Death was due to acute right-sided decompensation caused by obstruction of the pulmonary outflow tract from bilateral pulmonary thromboemboli. Paradoxical thromboemboli pass from the venous system into the systemic circulation through intracardiac or intrapulmonary shunts causing ischemic injury to the brain, heart, intestines, kidneys and limbs. Very rarely, as in this case, they may become entrapped in a patent foramen ovale. Due to its entrapment the paradoxical embolism did not play a role in the lethal episode.


Paradoxical embolus Pulmonary thromboembolism Deep venous thrombosis Atrial septal defect Shunting 


Compliance with ethical standards

Ethical approval

This paper was approved by Forensic Science SA management.

Conflict of interest

The author declares that he has no conflicts of interest.


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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Faculty of MedicineThe University of AdelaideAdelaideAustralia
  2. 2.Forensic Science SAAdelaideAustralia

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