External iliac vein aneurysm as a cause of paradoxical embolism.

Iliac vein aneurysms are rare, even among venous aneurysms. We report the first case of an external iliac vein aneurysm presenting with paradoxical embolism to bilateral lower extremities. Workup after embolectomy demonstrated a patent foramen ovale along with the aneurysm and an inferior vena cava obstruction, which was treated with balloon angioplasty and ultimately stenting. The patient then underwent interval lateral aneurysmectomy. At 4-year follow-up, she is free of recurrence.