Vnitr Lek 2026, 72(5):338-340 | DOI: 10.36290/vnl.2026.064

Acute coronary syndrome without atherosclerosis: paradoxical coronary embolism in a patient with venous thromboembolism and occult lung adenocarcinoma

Mária Ivančíková¹, Martin Hudec¹, Zuzana Celecová²

¹ Oddelenie akútnej kardiológie, SÚSCCH a.s., Banská Bystrica, Slovensko

² Interné oddelenie, Dolnooravská NsP MUDr. L. N. Jégého, Dolný Kubín, Slovensko

The occurrence of acute coronary syndrome without angiographic evidence of atherosclerosis in combination with venous thromboembolism represents a diagnostically challenging situation with a potential systemic underlying cause.

We present the case of 50-year-old man with a recent deep vein thrombosis who was admitted with acute pulmonary embolism and concomitant acute coronary syndrome. Coronary angiography revealed distal occlusion of the ramus intermedius, which was treated by aspiration thrombectomy.

Transesophageal echocardiography (TEE) confirmed the presence of a patent foramen ovale (PFO). During the subsequent clinical course, the patient developed ischemic stroke and recurrent thromboembolic complications despite adequate anticoagulation therapy. Further diagnostic evaluation revealed lung adenocarcinoma as the underlying cause of a paraneoplastic hypercoagulable state.

This case highlights the importance of considering an embolic etiology of acute coronary syndrome in patients without angiographic evidence of coronary atherosclerosis and emphasizes the need to actively search for systemic causes, including occult malignancy, particularly in the presence of concomitant or recurrent thromboembolic events. 

Keywords: acute coronary syndrome, coronary embolism, paradoxical embolism, patent foramen ovale, pulmonary embolism, Trousseau syndrome, lung adenocarcinoma.

Accepted: August 20, 2026; Published: August 27, 2026  Show citation