Paradoxical embolus: an unusual indication for upper limb amputation

Paradoxical emboli occur when venous embolic material passes into the arterial circulation (via a right-to-left cardiac shunt). The association of paradoxical emboli and arterial ischaemia has been described previously, especially with respect to cerebral infarcts.(1,2) We describe a case in which double paradoxical emboli following a long haul flight, resulted in emergency amputation of an upper limb. Amputation resulting from a paradoxical embolus has not previously been described.