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 due to an ischemic stroke. Transesophageal echocardiography demonstrated the presence of an echogenic structure consistent with a thrombus within the aneurysm of the right atrium, along with a foramen ovale (PFO) within the interatrial septum. Cardiac MRI revealed the presence of a right atrial appendage aneurysm (RAAA) with a thrombus. Coronary angiography demonstrated that the circumflex artery was occluded. Concurrently, the antiphospholipid syndrome was identified. Given the presence of a PFO, paradoxical embolism was postulated as the aetiology of both coronary and cerebral artery occlusion. Antithrombotic and anticoagulant medical treatment was initiated, and surgical intervention for RAAA and PFO was advised. However, the patient declined surgical treatment, and thus, his medical management was continued. The patient has been attending regular visits for about two years and is being followed up without any problems.