Wide-ranging clinical spectrum of paradoxical embolism

2021 ◽  
pp. postgradmedj-2020-139691
Author(s):  
Oscar Jolobe
Keyword(s):  
Pulmonary Embolism ◽  
Arteriovenous Malformations ◽  
Coronary Circulation ◽  
Vena Cava ◽  
Paradoxical Embolism ◽  
Lower Limbs ◽  
Atrial Septal Aneurysm ◽  
Pulmonary Arteriovenous Malformations ◽  
Mesenteric Circulation ◽  
Venous Shunt

The purpose of this review is to raise the index of suspicion for paradoxical embolism among generalists. The review is based solely on anecdotal reports compiled from EMBASE, MEDLINE, Googlescholar and Pubmed. Search terms were ‘paradoxical embolism’, ‘pulmonary embolism’ and ‘pulmonary arteriovenous malformations’. What emerged was that right-to-left paradoxical embolism could occur with or without concurrent pulmonary embolism, and also with and without proof of the presence of an ‘embolus-in-transit’. Potential sites of single or multiple systemic involvement included the central nervous system, the coronary circulation, renal arterial circulation, splenic circulation, the mesenteric circulation and the limbs. In many cases, the deep veins of the lower limbs were the source of thromboembolism. In other cases, thrombi originated from an atrial septal aneurysm, from a central venous line, from a haemodialysis-related arterio-venous shunt, from a popliteal vein aneurysm, internal jugular vein, superior vena cava, from a pulmonary arteriovenous malformation, from tricuspid valve endocarditis (with and without pulmonary embolism) and from the right atrium, respectively. Stroke was by far the commonest systemic manifestation of paradoxical embolism. Some strokes were attributable to pulmonary arteriovenous malformations with or without coexistence of intracardiac shunts. Clinicians should have a high index of suspicion for paradoxical embolism because of its time-sensitive dimension when it occurs in the context of involvement of the intracranial circulation, coronary circulation, mesenteric circulation, and peripheral limb circulation.

scholarly journals Stroke and Respiratory Failure: Mind the Shunt!

2021 ◽  
Author(s):  
Diana Mano ◽  
Patrícia Campos ◽  
Bruno Vale ◽  
Alexandre Pinto
Keyword(s):  
Pulmonary Embolism ◽  
Respiratory Failure ◽  
Arteriovenous Malformations ◽  
Thrombotic Event ◽  
Paradoxical Embolism ◽  
Pulmonary Arteriovenous Malformations ◽  
Rare Entity ◽  
Stroke Patients ◽  
Arterial Embolism ◽  
Orthostatic Position

When stroke patients present with respiratory failure, the first thought that clinicians have is that it is probably related to aspiration pneumonia. However, other causes should be considered, such as intracardiac or intrapulmonary shunts, that could present with paradoxical embolism. Paradoxical embolism is a rare entity defined by the occurrence of a venous thrombotic event associated with a systemic arterial embolism. Frequently, paradoxical embolism presents with platypnoea-orthodeoxia syndrome. Platypnoea-orthodeoxia syndrome is uncommon and is characterized by dyspnoea and hypoxaemia induced by orthostatic position, where symptoms and oxygenation are relieved by recumbency. The authors report a case of a patient who presented with an ischaemic stroke and progression to platypnoea-orthodeoxia syndrome with documentation of simultaneous pulmonary embolism and pulmonary arteriovenous malformations.

scholarly journals A rare case of paradoxical pulmonary embolism in spontaneous aortocaval fistula

2021 ◽  
pp. 20200183
Author(s):  
Valentina Vespro ◽  
Stefano Fusco ◽  
Anna Maria Ierardi ◽  
Viviana Grassi ◽  
Ilenia D’Alessio ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Inferior Vena ◽  
Rare Complication ◽  
Vena Cava ◽  
Paradoxical Embolism ◽  
Aortocaval Fistula ◽  
Shortness Of Breath ◽  
Right Heart ◽  
Abdominal Ct ◽  
Abdominal Aortic

Aortocaval fistula (ACF) is a rare complication of abdominal aortic aneurysm (AAA), occurring in less than 1% of all AAAs. Paradoxical embolism can rarely be associated with ACF, pulmonary embolism may originate from dislodgment of thrombotic material from the AAA in the inferior vena cava (IVC) through the ACF. We report a case of a patient admitted to the emergency department with abdominal pain and shortness of breath who immediately underwent thoraco-abdominal CT. Imaging allowed a prompt pre-operative diagnosis of an ACF between an AAA and the IVC, also identifying CT signs of right heart overload and the presence of a paradoxical pulmonary embolism.

scholarly journals Pulmonary arteriovenous malformations in a patient with single ventricle and polysplenia syndrome

2019 ◽  
Vol 12 (7) ◽  
pp. e229491
Author(s):  
Shinichiro Sakaki ◽  
Taiyu Hayashi ◽  
Hiroshi Ono
Keyword(s):  
Arteriovenous Malformations ◽  
Single Ventricle ◽  
Vena Cava ◽  
Portosystemic Shunt ◽  
Pulmonary Arteriovenous Malformations ◽  
Polysplenia Syndrome ◽  
Abdominal Angiography ◽  
Venous Filling ◽  
Congenital Extrahepatic Portosystemic Shunt ◽  
Kawashima Operation

A 5-month-old girl with single ventricle, interrupted inferior vena cava and polysplenia syndrome palliated with bilateral Blalock-Taussig shunts developed severe cyanosis despite apparently increased pulmonary blood flow. Angiography revealed diffuse pulmonary arteriolar capillary dilatation and early pulmonary venous filling, suggesting the presence of pulmonary arteriovenous malformations. Abdominal angiography at 6 months demonstrated a large extrahepatic portosystemic shunt, which was percutaneously closed with a vascular plug. Kawashima operation was performed 2 weeks after portosystemic shunt closure. Although cyanosis improved temporarily, the patient suffered from deteriorating cyanosis at 9 months of age and underwent Fontan completion. Thereafter, her oxygen saturation gradually improved to 95% over the course of 3 weeks. Both the congenital extrahepatic portosystemic shunt and Kawashima operation contributed to the development of pulmonary arteriovenous malformations.

scholarly journals Radioechocardiography in the evaluation of pulmonary hypertension

2016 ◽  
Vol 97 (6) ◽  
pp. 982-988
Author(s):  
R F Akberov ◽  
S R Zogot ◽  
N A Tsibul’kin
Keyword(s):  
Pulmonary Embolism ◽  
Pulmonary Hypertension ◽  
Pulmonary Artery ◽  
Inferior Vena Cava ◽  
Digital Radiography ◽  
Right Atrium ◽  
Inferior Vena ◽  
Vena Cava ◽  
Lower Limbs ◽  
The Right

Aim. To study the capabilities of radioechocardigraphy in the evaluation of pulmonary hypertension of various causes, early non-invasive detection of pressure increase in the pulmonary artery.Methods. The study included 800 patients with congenital (269) and acquired (217) mitral valve diseases, pulmonary embolism (140), primary pulmonary hypertension (57), coronary heart disease with acute myocardial infarction (117) of different age and gender. Digital radiography, linear tomography of chest, ECG, echocardiography, multidetector computed tomography angiography, and ultrasound of inferior vena cava were performed.Results. Radiocardiography combined with linear tomography and measurement of Moore index, right atrium index, transpulmonary distance, and width of right descending pulmonary artery at the level of intermediate bronchus, allows determining the degree, type (arterial, venous, capillary, and mixed) and cause of pulmonary hypertension. Digital radiography and linear tomography in 80% cases reveal signs of pulmonary embolism. Echocardiography makes it possible to study hemodynamics in pulmonary hypertension, to detect the dilation of the right heart, inferior vena cava, and renal veins, and to calculate the systolic pressure in the right ventricle, pulmonary artery, and right atrium. Radioechocardigraphy allows determining the cause and degree of pulmonary hypertension, and hemodynamic disorders. Sensitivity of the method for diagnosis of pulmonary hypertension is 89%, specificity is 90%, and precision is 92%.Conclusion. Radioechocardigraphy is a highly effective method for diagnosis of pulmonary hypertension; ultrasound of inferior vena cava, iliac veins, and veins of the lower limbs allows to determine the source of pulmonary embolism, to diagnose embologenicity of thromboses and to evaluate the need for vena cava filters.

scholarly journals Management of Symptomatic Venous Aneurysm

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Roberto Gabrielli ◽  
Maria Sofia Rosati ◽  
Andrea Siani ◽  
Luigi Irace
Keyword(s):  
Pulmonary Embolism ◽  
Paradoxical Embolism ◽  
Lower Limbs ◽  
Venous Aneurysm ◽  
Pulmonary Emboli ◽  
Duplex Scan ◽  
Deep Venous System ◽  
Simple Excision ◽  
Life Threatening ◽  
Aneurysm Thrombosis

Venous aneurysms (VAs) have been described in quite of all the major veins. They represent uncommon events but often life-threatening because of pulmonary or paradoxical embolism. We describe our twelve patients’ series with acute pulmonary emboli due to venous aneurysm thrombosis. Our experience underlines the importance of a multilevel case-by-case approach and the immediate venous lower limbs duplex scan evaluation in pulmonary embolism events. Our data confirm that anticoagulant alone is not effective in preventing pulmonary embolism. We believe that all the VAs of the deep venous system of the extremities should be treated with surgery as well as symptomatic superficial venous aneurysm. A simple excision can significantly improve symptoms and prevent pulmonary embolism.

Concomitant pulmonary embolism and upper limb ischaemia as a first presentation of a patent foramen ovale

2021 ◽  
Vol 14 (10) ◽  
pp. e242351
Author(s):  
Tessa Houtzager ◽  
Ingvar Berg ◽  
Thijs Urlings ◽  
Robert Grauss
Keyword(s):  
Pulmonary Embolism ◽  
Patent Foramen Ovale ◽  
Paradoxical Embolism ◽  
Atrial Septal Aneurysm ◽  
Limb Ischaemia ◽  
Foramen Ovale ◽  
Intravenous Contrast ◽  
Arterial Embolism ◽  
Artery Embolism ◽  
Peripheral Arterial

A 78-year-old female patient presented to the emergency department with syncope and dyspnoea. The left arm appeared to be cold and radial pulse was not palpable. A CT scan of the chest and left arm with intravenous contrast displayed bilateral central pulmonary embolisms in combination with a left subclavian artery embolism and an atrial septal aneurysm. Transthoracic echocardiography identified a patent foramen ovale with right-to-left shunting confirming the diagnosis of paradoxical embolism. The patient was treated with anticoagulants. In a patient presenting with a combination of a pulmonary embolism and a peripheral arterial embolism, the clinician should consider a right-to-left shunt with paradoxical embolism. In line with this, when diagnosing a peripheral arterial embolism, a central venous origin should be considered. Furthermore, when diagnosing a pulmonary embolism or other forms of venous thromboembolism, the clinician should be aware of signs of a peripheral arterial embolism.

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