Thrombus in Transit with Isolated Paradoxical Embolism to the Subclavian Artery.

Paradoxical embolism is an uncertain entity triggering significant debate. A thrombus in transit across a patent foramen ovale is a rarity, a potential catastrophe with nonuniform management recommendations, and theoretically the objective proof that paradoxical embolism is real. We present a case in a postoperative setting, with a thrombus in transit across a patent foramen ovale. Pulmonary embolization was clinically silent and diagnosed incidentally, and systemic embolization was isolated but extensive to the subclavian artery. The case stimulates many unanswered questions and possible scenarios.