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.

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 A case of dyspnea: respiratory failure due to pulmonary arteriovenous malformation

2019 ◽  
Vol 13 (4) ◽  
pp. 244-246
Author(s):  
Lucio Brugioni ◽  
Chiara Catena ◽  
Eugenio Ferraro ◽  
Serena Scarabottini ◽  
Francesca Mori ◽  
...  
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Respiratory Failure ◽  
General Population ◽  
Arteriovenous Malformations ◽  
Pulmonary Arteries ◽  
Pulmonary Nodules ◽  
Pulmonary Arteriovenous Malformations ◽  
Angio Ct ◽  
Arteries And Veins

Pulmonary arteriovenous malformations (PAVMs) are abnormal communications between pulmonary arteries and veins. The clinical features suggestive of PAVMs are stigmata of right-to-left shunting (dyspnea, hypoxemia, cyanosis, cerebral embolism, brain abscess), unexplained hemoptysis, or hemothorax.We present a case of young man presented to Emergency Department complaining dyspnea, polycythemia and persistent hypoxemia. Angio-CT scan of the chest detected multiple PAVMs.PAVMs are uncommon in the general population, but they are an important consideration in the differential diagnosis of common pulmonary problems, including hypoxemia, pulmonary nodules, and hemoptysis

Paradoxical Arterial Embolism Involving Both Upper Extremities in a Patient With Pulmonary Embolism and a Patent Foramen Ovale

2010 ◽  
Vol 17 (6) ◽  
pp. E98-E101 ◽  
Author(s):  
O. S. Kouskov ◽  
D. J. Nichols ◽  
D. J. O’Hearn
Keyword(s):  
Pulmonary Embolism ◽  
Patent Foramen Ovale ◽  
Treatment Options ◽  
Paradoxical Embolism ◽  
The Body ◽  
Upper Extremities ◽  
Foramen Ovale ◽  
Arterial Embolism ◽  
Clinical Presentations ◽  
Significant Disability

Paradoxical embolization is an uncommon but devastating complication of pulmonary embolism (PE). Awareness of this complication with prompt recognition and treatment could serve to preclude significant disability and death. Described is a case of PE associated with paradoxical embolism to the arteries of both upper extremities. While patent foramen ovale (PFO) is common, paradoxical embolism is infrequent but can involve almost any artery of the body. Discussed are the risk factors, clinical presentations, and diagnostic and treatment options for paradoxical embolism. Awareness of the potential for paradoxical embolization in patients with PE is essential to its prompt recognition and treatment.

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.

scholarly journals Massive haemorrhagic complications of ruptured pulmonary arteriovenous malformations: outcomes from a 12 years’ retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xu Ma ◽  
Bing Jie ◽  
Dong Yu ◽  
Ling-Ling Li ◽  
Sen Jiang
Keyword(s):  
Arteriovenous Malformations ◽  
Arterial Oxygen Saturation ◽  
Arterial Oxygen ◽  
Hereditary Haemorrhagic Telangiectasia ◽  
Pulmonary Arteriovenous Malformations ◽  
Imaging Data ◽  
Peripheral Lung ◽  
Life Threatening ◽  
The Mean

Abstract Background The life-threatening haemorrhagic complications of pulmonary arteriovenous malformations (PAVMs) are extremely rare, and only described in isolated cases. This study was designed to comprehensively investigate management of ruptured PAVMs. Methods We retrospectively assessed clinical and imaging data of ruptured PAVMs to summarize incidence, clinical characteristics, and outcomes following embolisation between January 2008 and January 2021. Results Eighteen of 406 (4.4%) patients with PAVMs developed haemorrhagic complications. Twelve of 18 patients were clinically diagnosed with hereditary haemorrhagic telangiectasia (HHT). Haemorrhagic complications occurred with no clear trigger in all cases. Eight of 18 patients (44.4%) were initially misdiagnosed or had undergone early ineffective treatment. 28 lesions were detected, with 89.3% of them located in peripheral lung. Computed tomography angiography (CTA) showed indirect signs to indicate ruptured PAVMs in all cases. Lower haemoglobin concentrations were associated with the diameter of afferent arteries in the ruptured lesions. Successful embolotherapy was achieved in all cases. After embolotherapy, arterial oxygen saturation improved and bleeding was controlled (P < 0.05). The mean follow-up time was 3.2 ± 2.5 years (range, 7 months to 10 years). Conclusions Life threatening haemorrhagic complications of PAVMs are rare, they usually occur without a trigger and can be easily misdiagnosed. HHT and larger size of afferent arteries are major risk factors of these complications. CTA is a useful tool for diagnosis and therapeutic guidance for ruptured PAVMs. Embolotherapy is an effective therapy for this life-threatening complication.

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