{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T06:10:10Z","timestamp":1756361410716,"version":"3.44.0"},"reference-count":12,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,7,9]]},"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:p>A 65-year-old man presented in a peri-arrest situation after collapse, he was found hypoxic with ischaemic arms. CT imaging showed massive bilateral pulmonary embolisms (PEs) and an aortic arch embolus extending from brachiocephalic trunk to left subclavian artery. Following intravenous thrombolysis, repeat imaging revealed that the aortic embolus had migrated distally into both axillary arteries and had occluded the right carotid from origin to skull base. Bilateral upper limb embolectomies were carried out from the brachial arteries together with forearm fasciotomies. Left hemianopia related to a right middle cerebral artery territory infarct was managed conservatively; forearm fasciotomy wounds were primarily closed and the patient was discharged on lifelong anticoagulation. A transoesophageal echocardiogram revealed a patent foramen ovale. This case demonstrates a very unusual presentation of concomitant PE and paradoxical saddle aortic arch embolism. A multidisciplinary approach has resulted in an excellent clinical outcome for this complex patient.<\/jats:p>","DOI":"10.1136\/bcr-2019-230024","type":"journal-article","created":{"date-parts":[[2019,8,29]],"date-time":"2019-08-29T07:36:47Z","timestamp":1567064207000},"page":"e230024","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Management and clinical outcome of concomitant pulmonary embolism and paradoxical saddle aortic arch embolism"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6324-8255","authenticated-orcid":false,"given":"Enrico","family":"Mancuso","sequence":"first","affiliation":[{"name":"Vascular Surgery, Addenbrooke\u2019s Hospital, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew Philip","family":"Winterbottom","sequence":"additional","affiliation":[{"name":"Radiology, Addenbrooke\u2019s Hospital, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan R","family":"Boyle","sequence":"additional","affiliation":[{"name":"Vascular Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diane R","family":"Hildebrand","sequence":"additional","affiliation":[{"name":"Vascular Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,8,28]]},"reference":[{"key":"2025082722413313000_12.8.e230024.1","doi-asserted-by":"publisher","DOI":"10.1097\/00001573-199609000-00011"},{"key":"2025082722413313000_12.8.e230024.2","first-page":"82","article-title":"A case of massive aortic mural thrombus in the absence of atherosclerotic or aneurysmal disease","volume":"12","author":"Haji","year":"2016","journal-title":"IJC Hear Vasc"},{"key":"2025082722413313000_12.8.e230024.3","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9610(82)90196-9"},{"key":"2025082722413313000_12.8.e230024.4","first-page":"B1","article-title":"Patent foramen ovale and paradoxical systemic embolism: a bibliographic review","volume":"74","author":"Foster","year":"2003","journal-title":"Aviat Space Environ Med"},{"key":"2025082722413313000_12.8.e230024.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(99)00604-X"},{"key":"2025082722413313000_12.8.e230024.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2012.03.011"},{"key":"2025082722413313000_12.8.e230024.7","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1111\/j.1540-8175.2011.01606.x","article-title":"Arterial embolism caused by large mobile aortic thrombus in the absence of atherosclerosis, associated with iron deficiency anemia","volume":"29","author":"Bukharovich","year":"2012","journal-title":"Echocardiography"},{"key":"2025082722413313000_12.8.e230024.8","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1016\/j.jtcvs.2016.03.078","article-title":"Management of floating thrombus in the aortic arch","volume":"152","author":"Weiss","year":"2016","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2025082722413313000_12.8.e230024.9","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1016\/j.jvs.2017.05.109","article-title":"Descending thoracic aortic mural thrombus presentation and treatment strategies","volume":"66","author":"Meyermann","year":"2017","journal-title":"J Vasc Surg"},{"key":"2025082722413313000_12.8.e230024.10","doi-asserted-by":"crossref","first-page":"1610","DOI":"10.1016\/j.avsg.2014.03.028","article-title":"Atypical aortic thrombus: should nonoperative management be first line?","volume":"28","author":"Turley","year":"2014","journal-title":"Ann Vasc Surg"},{"key":"2025082722413313000_12.8.e230024.11","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/j.clineuro.2014.08.008","article-title":"Management of free-floating thrombus within the arcus aorta and supra-aortic arteries","volume":"125","author":"G\u00fclc\u00fc","year":"2014","journal-title":"Clin Neurol Neurosurg"},{"key":"2025082722413313000_12.8.e230024.12","unstructured":"Erbel R , Aboyans V , Boileau C , et al . 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