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Year : 2015  |  Volume : 5  |  Issue : 1  |  Page : 50-52

An uncommon pulmonary embolism

1 Department of Respiratory, Hospital, Pellegrin; Université Bordeaux-II Segalen, Bordeaux, France
2 Department of Cardiology, Groupe Hospitalier Paris Saint Joseph; University of Paris Descartes, Sorbonne Cite, Paris, France
3 Department of Critical Care, Groupe Hospitalier Paris Saint Joseph, Paris, France

Correspondence Address:
François Philippart
Critical care department, Groupe Hospitalier Paris Saint Joseph, 185 Rue R. Losserand, 75014 Paris
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2229-5151.152345

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Objectives: To report an unusual case of suicide attempt secondary complicated of pulmonary and systemic embolisms. Data Source: A 49-year-old-woman, with a factor V Leiden mutation and a notion of chronic depression, admitted to our intensive care unit for a suicide attempt by ingestion ofmepronizine and lormetazepam. Data Extraction: We report the rare evolution of this patient with a persistent alteration of consciousness associating a respiratory degradation. Despite the drug intoxication and possibility of aspiration, we performed a computed tomography (CT) angiography which confirmed the presence of a bilateral, proximal, pulmonary embolism suspected on transthoracic echocardiography. A cerebral CT showed left sylvian and cerebellar infarctions complicated of perilesional edema. Association of stroke and pulmonary embolism led us to suspect a patent foramen ovale (PFO). There was also a context of genetical perturbation of hemostasis. Transesophageal echocardiography confirmed the presence of a PFO undiagnosed by transthoracic echography. The PFO was complicated by an entrapped thrombus. The thrombotic complications were treated by unfractionated heparin. Data Synthesis: Neurological and respiratory degradation following voluntary drug intoxication led to the discovery of both a pulmonary and cerebral embolism secondary to a PFO entrapped thrombus. Conclusions: An entrapped thrombus in a PFO is a rare and dangerous situation, associated with many complications. Association of systemic and pulmonary embolisms should lead to PFO detection to guide therapeutic interventions.

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