Clinical SpotlightMassive Pulmonary Embolism and Acute Limb Ischaemia in a Patient of Hereditary Spherocytosis and Patent Foramen Ovale
Introduction
The role of paradoxical embolism is usually underestimated in the embolic disease of peripheral arteries. It may be asymptomatic but sometimes fatal and, therefore, needs early diagnosis and treatment. Simultaneous arterial and venous thrombosis should always arouse the suspicion of a paradoxical embolism via a right-to-left shunt, most commonly a patent foramen ovale (PFO) [1].
Section snippets
Case Report
A 41 year-old Caucasian male came to the emergency department with shortness of breath and numbness of both lower limbs (Left > Right). He gave a history of air travel (total flight time seven hours), 15 days prior to admission after which he developed mild shortness of breath, which worsened on the day before admission. There was no history of chest pain, haemoptysis, dizziness, or loss of consciousness. Splenectomy was done for him in childhood for hereditary spherocytosis. He does not have a
Discussion
Hereditary spherocytosis is an uncommon familial haemolytic disorder. Increased thrombotic risk is usually not a complication of this disorder, though there are a few case reports of arterial and venous thrombosis and pulmonary thromboembolism in the literature [2], [3], [4]. The cause has been attributed to post-splenectomy thrombocytosis and other factors. In our patient, thrombophilia workup and platelet count have been in normal range.
Air travel is considered an independent risk factor for
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