Paradoxical embolism and patent foramen ovale have represented an issue of great interest during the last years, because of the strong correlation with cryptogenic stroke in young patients. The coexistence of pulmonary and paradoxical embolism is even more rare. We present the case of a patient with evidence of concomitant pulmonary embolism and paradoxical systemic arterial embolism, which suggests the presence of patent foramen ovale. The available literature about this infrequent clinical event is also reviewed.