Paradoxical Cerebral and Coronary Embolism in a Young Patient Due to Right Atrial Appendage Aneurysm: A Case Report

A 32-year-old male patient was admitted to the hospital with an ischemic stroke. Transesophageal echocardiography revealed an echogenic structure consistent with a thrombus within the aneurysm of the right atrium, along with a patent foramen ovale (PFO) in the interatrial septum. Cardiac magnetic resonance imaging (MRI) confirmed the presence of a right atrial appendage aneurysm (RAAA) with thrombus formation. Coronary angiography demonstrated occlusion of the circumflex artery. Concurrently, the patient was diagnosed with antiphospholipid syndrome. Given the presence of a PFO, paradoxical embolism was postulated as the etiology for both the coronary and cerebral artery occlusions. Antithrombotic and anticoagulant therapy was initiated, and surgical intervention for the RAAA and PFO was recommended. However, the patient declined surgical treatment, and medical management was continued. The patient has been regularly followed for approximately two years without any complications.

Keywords: Acute coronary syndrome, acute ischemic stroke, right atrial appendage aneurysm