Kidney Transplant Recipient With Cerebral Paradoxical Embolism Following Recurrent Idiopathic Deep Vein Thrombosis and Pulmonary Embolism: Case Report and Review of the Literature

Exp Clin Transplant. 2024 Jan;22(Suppl 1):348-353. doi: 10.6002/ect.MESOT2023.P38.


Paradoxical embolism occurs when a thrombus crosses an intracardiac defect into the systemic circulation. Here, we present the case of a 35-yearold male kidney transplant recipient with a cerebral paradoxical embolism associated with a spontaneous venous thromboembolism. This patient had recurrent deep venous thrombosis and showering emboli to the lung and paradoxically to the brain through patent foramen ovale, and we treated him successfully. The role of bubble echocardiography was essential in diagnosis to avoid contrast-induced nephropathy. This is the first successfully managed case of a kidney transplant recipient with recurrent idiopathic deep vein thrombosis, pulmonary embolism, and cerebral paradoxical embolism. Bubble echocardiography was an excellent alternative to contrast angiography to avoid nephrotoxicity. Vitamin K antagonists are superior to direct oral anticoagulants, especially among nonadherent/noncompliant patients.

Publication types

  • Review
  • Case Reports

MeSH terms

  • Adult
  • Anticoagulants / therapeutic use
  • Embolism, Paradoxical* / diagnostic imaging
  • Embolism, Paradoxical* / etiology
  • Embolism, Paradoxical* / surgery
  • Foramen Ovale, Patent* / complications
  • Humans
  • Kidney Transplantation* / adverse effects
  • Male
  • Pulmonary Embolism* / diagnostic imaging
  • Pulmonary Embolism* / drug therapy
  • Pulmonary Embolism* / etiology
  • Venous Thrombosis* / diagnostic imaging
  • Venous Thrombosis* / drug therapy
  • Venous Thrombosis* / etiology


  • Anticoagulants