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This case report describes a 64-year-old male patient, who presented with sudden onset dyspnoea. A chest CT-angiography revealed the presence of central bilateral pulmonary embolisms (PE), and he was admitted for anticoagulative treatment. Shortly after admission, he developed discomfort and pulselessness in the right leg, and a limb CT-angiography revealed a femoral artery thrombus. PE in conjunction with acute limb ischaemia raised suspicion of a paradoxical mechanism of systemic embolism, which was confirmed by echocardiography with

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