A previously-healthy 47-year-old man presented with recent onset abdominal pain exacerbated by meals. He had recently had a long return flight from overseas. Workup included HIDA scan which showed filling of the gallbladder but slow emptying (20%). Upper endoscopy showed mild esophagitis and gastritis. Laboratory values were normal.
CT scan of the abdomen showed possible thrombus in the superior mesenteric artery (SMA). Echocardiogram revealed an atrial septal defect. A presumptive diagnosis of paradoxical embolus was made.
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