Image section of computed tomography in axial view of the heart. In this patient, a fulminant pulmonary embolism (white arrow) was observed in addition to the cerebral large-vessel occlusion. In cardiac imaging as part of the CS-CT protocol, a contrast jet in atrial septal defect with right-left shunt could be seen (black arrow), presumably as a cardiac cause of stroke due to additional paradoxical embolism. A TEE was not possible due to the poor general condition of the patient