{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,29]],"date-time":"2025-09-29T15:34:18Z","timestamp":1759160058248,"version":"3.41.2"},"reference-count":4,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2023,7,27]],"date-time":"2023-07-27T00:00:00Z","timestamp":1690416000000},"content-version":"vor","delay-in-days":26,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Paradoxical embolism is a rare cause of arterial embolism, even more those resulting in acute ischemia of the upper limb. A case of a 45-year-old patient with acute paradoxical upper limb embolization and acute limb ischemia is presented. A review of the most recent evidence on the diagnosis and management of paradoxical embolism were explored. The cardiac defect most associated with paradoxical embolism is a patent foramen oval. The diagnosis can be performed by transthoracic or transesophageal echocardiography. Closure of the foramen oval is a safe and effective procedure; however, there is no clear consensus on when it should be performed, so the strategy should be individualized. A high level of suspicion of paradoxical embolism should exist in the presence of simultaneous venous and arterial embolism. The investigation of the embolic source is fundamental to avoid the recurrence of events.<\/jats:p>","DOI":"10.1093\/jscr\/rjad435","type":"journal-article","created":{"date-parts":[[2023,7,27]],"date-time":"2023-07-27T22:29:25Z","timestamp":1690496965000},"source":"Crossref","is-referenced-by-count":1,"title":["Paradoxical embolism: a rare cause of acute upper limb ischemia"],"prefix":"10.1093","volume":"2023","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2252-9872","authenticated-orcid":false,"given":"Roberto","family":"Cunha","sequence":"first","affiliation":[{"name":"Angiology and Vascular Surgery Department, Hospital do Divino Esp\u00edrito Santo (HDES) , Ponta Delgada, S\u00e3o Miguel Island, Azores, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuel","family":"Silva","sequence":"additional","affiliation":[{"name":"Angiology and Vascular Surgery Department, Hospital do Divino Esp\u00edrito Santo (HDES) , Ponta Delgada, S\u00e3o Miguel Island, Azores, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Henrique","sequence":"additional","affiliation":[{"name":"Angiology and Vascular Surgery Department, Hospital do Divino Esp\u00edrito Santo (HDES) , Ponta Delgada, S\u00e3o Miguel Island, Azores, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6999-3539","authenticated-orcid":false,"given":"Pedro","family":"Maximiano","sequence":"additional","affiliation":[{"name":"Angiology and Vascular Surgery Department, Hospital do Divino Esp\u00edrito Santo (HDES) , Ponta Delgada, S\u00e3o Miguel Island, Azores, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1134-7400","authenticated-orcid":false,"given":"Mafalda","family":"Correia","sequence":"additional","affiliation":[{"name":"Angiology and Vascular Surgery Department, Hospital do Divino Esp\u00edrito Santo (HDES) , Ponta Delgada, S\u00e3o Miguel Island, Azores, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8131-6116","authenticated-orcid":false,"given":"Isabel","family":"Vieira","sequence":"additional","affiliation":[{"name":"Angiology and Vascular Surgery Department, Hospital do Divino Esp\u00edrito Santo (HDES) , Ponta Delgada, S\u00e3o Miguel Island, Azores, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabel","family":"C\u00e1ssio","sequence":"additional","affiliation":[{"name":"Angiology and Vascular Surgery Department, Hospital do Divino Esp\u00edrito Santo (HDES) , Ponta Delgada, S\u00e3o Miguel Island, Azores, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6737-3691","authenticated-orcid":false,"given":"Nelson","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Angiology and Vascular Surgery Department, Hospital do Divino Esp\u00edrito Santo (HDES) , Ponta Delgada, S\u00e3o Miguel Island, Azores, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emanuel","family":"Dias","sequence":"additional","affiliation":[{"name":"Angiology and Vascular Surgery Department, Hospital do Divino Esp\u00edrito Santo (HDES) , Ponta Delgada, S\u00e3o Miguel Island, Azores, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,7,27]]},"reference":[{"key":"2023082106485810600_ref1","doi-asserted-by":"crossref","DOI":"10.1016\/j.amsu.2021.102188","article-title":"Patent foramen oval: a rare case of acute ischemia of the upper limb: a case with 2 year follow-up","volume":"63","author":"Kallel","year":"2021","journal-title":"Ann Med Surg"},{"key":"2023082106485810600_ref2","first-page":"10","article-title":"Systemic and venous thromboembolism: think about paradoxical embolism","volume":"2015","author":"Cachia","year":"2015","journal-title":"BMJ Case Rep"},{"key":"2023082106485810600_ref3","doi-asserted-by":"crossref","DOI":"10.1016\/j.amsu.2021.102426","article-title":"Multiple paradoxical embolisms revealing a patent foramen ovale in a patient with deep venous thrombosis: a case report","volume":"66","author":"Banana","year":"2021","journal-title":"Ann Med Surg"},{"key":"2023082106485810600_ref4","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/j.hlc.2011.10.001","article-title":"Thrombolytic treatment of simultaneous pulmonary embolism and impending paradoxical embolism through a patent foramen ovale: a different thrombolytic regimen","volume":"21","author":"Turfan","year":"2012","journal-title":"Heart Lung Circ"}],"container-title":["Journal of Surgical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2023\/7\/rjad435\/51176388\/rjad435.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2023\/7\/rjad435\/51176388\/rjad435.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T06:49:25Z","timestamp":1692600565000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jscr\/article\/doi\/10.1093\/jscr\/rjad435\/7232310"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7]]},"references-count":4,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2023,7,3]]}},"URL":"https:\/\/doi.org\/10.1093\/jscr\/rjad435","relation":{},"ISSN":["2042-8812"],"issn-type":[{"type":"electronic","value":"2042-8812"}],"subject":[],"published-other":{"date-parts":[[2023,7]]},"published":{"date-parts":[[2023,7]]},"article-number":"rjad435"}}