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Paradoxical embolus illustrating speed of action of recombinant tissue plasminogen activator in massive pulmonary embolism
  1. H Madani1,
  2. P A Ransom2
  1. 1Royal Free NHS Trust Hospital, London, UK
  2. 2Department of Emergency Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
  1. Correspondence to:
 Dr H Madani
 Royal Free NHS Trust Hospital, Pond Street, London NW3 2QG, UK; h.madani{at}


A case of a patient who presented with massive pulmonary embolism (PE) requiring thrombolysis with alteplase is reported. The subsequent presence of a patent foramen ovale and paradoxical embolism clinically demonstrated the speed of action of the recombinant tissue plasminogen activator. The advantage of this class of medication when considering the treatment options for a PE in an acute setting is highlighted.

  • ECHO, echocardiography
  • PE, pulmonary embolism
  • PFO, patent foramen ovale

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  • Competing interests: None.

  • Informed consent was obtained from the patient for publication of her details in this report.