Amir Behnam Kharazmi1,  Sahar Mirbaha2,  Hamidreza Hatamabadi3,  Fatemeh Shojaeian4, Fatemeh Omidi5

1Department of Internal Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2Department of Emergency Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3Department of Emergency Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4Department of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
5Department of Cardiology, School of Medicine, Imam Hossein Hospital, Shahid Behehsti University of Medical Sciences, Tehran, Iran

Keywords: Case report, coronavirus disease 2019, fibrinolytic therapy, impending paradoxical embolism, massive pulmonary emboli

Abstract

Here, we reported a 32-year-old male presenting to the emergency department with respiratory symptoms and coronavirus disease 2019 (COVID-19) diagnosis. Multiple thrombi were detected in his heart and inferior vena cava, probably due to former deep-vein thrombosis. The presence of patent foramen ovale and high pressure of the right heart caused the clots to enter the heart's left side. He received fibrinolytics, and his condition improved with no need for surgery. Hence, patients with impending paradoxical embolism may take advantage of medical treatment, such as fibrinolytics. Moreover, COVID-19 appears to be associated with a strong thrombotic tendency, and anticoagulants might be helpful.

Author Contributions

F.O: conceived of the presented idea; AK, H.H and F.Sh.: wrote the manuscript in consultation with all authors; AK, S.M, and H.H: conceived the study and were in charge of overall direction and planning; AK, S.M, H.H, and F.O: were directly involved in the treatment plan of the patients; F.O has conducted the TTE and reported PCTA; All authors discussed the results and commented on the manuscript.

Conflict of Interest

None Declared.

Financial Disclosure

None.

Acknowledgments

We would like to thank Dr. Masoomeh Raoufi for obtaining the images and pictures presented in this case report.