Objective To improve the knowledge of paradoxical embolism originated from pulmonary embolism. Methods The medical literature about pulmonary embolism complicated with paradoxical embolism from 1998 to 2011 was searched from “Wanfang medical literature database”. Meanwhile 1 case diagnosed in Central Hospital of Dazhou City was reported. Then the clinical characteristics were summarized. Results 51 cases of pulmonary embolism complicated with paradoxical embolism were diagnosed, aged from23 to 76 years old. There were 27 males and 23 females, and sex was unknown in 1 case. In all cases, the cerebral embolism occurred in 30 cases( 58. 8% ) , lower limb artery embolism in 14 cases( 27. 4% ) , kidney artery embolism in 6 cases( 11. 8% ) , patent foramen ovale with straddling thrombus in 4 cases( 8% ) ,multiple embolismin 8 cases( 15. 7% ) , heart ventricle with straddling thrombus in 1 case ( 1. 96% ) , coronary artery embolism in 1 case( 1. 96% ) , aorta embolism in 1 case( 1. 96% ) , and spleen embolism in 1 case ( 1. 96% ) . There were 35 patients ( 68. 8% ) with patent foramen ovale and 7 cases ( 13. 7% ) died. Conclusions Paradoxical embolism waranted more awareness in the cases of pulmonary embolismand/ or venous thromboembolism and aggressive screening might avoid misdiagnosis.