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A young woman with syncope, dyspnea and abdominal pain.

We present the case of a 28-year-old woman admitted to our department with respiratory distress, profound hypotension, and tenderness in the left upper abdominal quadrant and left calf. Ultrasound examination revealed left lower extremity thrombus as well as a floating thrombus in the right atrium attached to a patent foramen ovale. Spiral computed tomography revealed bilateral pulmonary artery embolization, while an abdominal computed tomographic scan disclosed spleen infarction due to a paradoxical embolism through the patent foramen ovale.