Multimodality imaging approach to paradoxical embolism: a cauliflower mass on the Eustachian valve

The Eustachian valve was first described by Bartolomeo Eustachio (Italian anatomist) at 1552. It is an embryological remnant of the inferior vena cava valve that prenatally directs the oxygenated blood from inferior vena cava across the patent foramen ovale (PFO) into systemic circulation. Generally, following birth, after the closure of the foramen ovale it gradually regresses and not have a specific function, but it may persist in some patients as a floating membrane in the right atrium (RA), a nonpathological functionless structure.1 The prevalence of Eustachian valve in the normal population is unknown. Generally, it is an incidental finding without any significant pathophysiological consequences, but in some particular cases, unfortunately, it can become the site of thrombus formation and paradoxical embolic source.1 In our case report we describe a particular case of paradoxical systemic embolism due to a giant cauliflower thrombus on Eustachian valve, which caused ischemic stroke, pulmonary embolism and splenic infarction