Advertisement

Neurocritical Care

, Volume 30, Issue 2, pp 484–486 | Cite as

A Rare Case of Paradoxical Embolization During Thrombolysis for Pulmonary Embolus

  • Mitchell Onwochei-AsheiEmail author
  • William T. McGee
A Day in the Life of a Neurocritical Care Trainee
  • 63 Downloads

Introduction

Paradoxical embolization occurs when an embolus formed in the systemic venous circulation enters the systemic arterial circulation via an intracardiac shunt. The most common intracardiac shunt is a patent foramen ovale (PFO) present in approximately 25% of adults [1]. Other shunts which could allow for paradoxical embolization to occur include atrial septal defect, ventricular septal defect or extracardiac communications such as a pulmonary arteriovenous malformation [2].

Clinical Case

A 42-year-old woman with a past medical history of deep vein thrombosis (DVT) and chronic obstructive pulmonary disease, presented to the hospital with a complaint of sharp retrosternal chest pain worse with inspiration. She was hypotensive with a blood pressure of 90/30, heart rate of 138 beats per minute, respiratory rate of 30 breaths per minute, and an oxygen saturation of 78 percent on room air. An electrocardiogram revealed sinus tachycardia with an S1Q3T3 pattern. A computed...

Notes

Author contribution

MO-A was involved in the acquisition of data and detailing clinical note. WM was involved in the critical revision of manuscript for intellectual content.

Source of support

Funding information is not applicable/no funding was received.

Compliance with ethical standards

Conflict of interest

Mitchell Onwochei-Ashei and William McGee declare that they have no conflict of interest.

References

  1. 1.
    Meissner I, Whisant J, Khanderia B, et al. Prevalence of potential risk factors for stroke assessed by transesophageal echocardiography and carotid ultrasonography: the SPARC study. Stroke Prevention: assessment of Risk in a community. Mayo Clin Proc. 1999;74:862–9.CrossRefGoogle Scholar
  2. 2.
    Lamy C, Giannesini C, Zuber M, et al. Clinical and imaging findings in cryptogenic stroke patients with and without patent foramen ovale: the PFO-ASA study. Atrial septal aneurysm. Stroke. 2002;33:706.CrossRefGoogle Scholar
  3. 3.
    Carvalho J, Pinto J, Vidoedo J, Tenreiro J, Albuquerque R. Paradoxical peripheral embolism—a rare and underestimated event. Eur J Vasc Endovasc Surg. 2009;37:619.CrossRefGoogle Scholar
  4. 4.
    Langholz D, Louie E, Konstadt S, Rao T, Scanlon P. Transesophageal echocardiographic demonstration of distinct mechanisms for right to left shunting across a patent foramen ovale in the absence of pulmonary hypertension. J Am Coll Cardiol. 1991;18(4):1112.CrossRefGoogle Scholar
  5. 5.
    Sondergaard L, Kasner S, Rhodes J, et al. Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke. N Engl J Med. 2017;377:1033.CrossRefGoogle Scholar
  6. 6.
    Mas J, Derumeaux G, Guillon B, et al. Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke. N Engl J Med. 2017;377:1011.CrossRefGoogle Scholar
  7. 7.
    Saver J, Carroll J, Thaler D, et al. Long-term outcomes of patent foramen ovale closure of medical therapy after stroke. N Engl J Med. 2017;377:1022.CrossRefGoogle Scholar
  8. 8.
    Fan Z, Roedersheimer R, Lohr J. Systemic thrombolysis using tissue plasminogen activator for a patient with paradoxic embolism: a case report. Vasc Endovascular Surg. 2007;41(2):136–9.CrossRefGoogle Scholar
  9. 9.
    Oldenbüttel P, Antoni DH, Krieg HJ, Engel M, Wencke K, Delius W. Combined lytic and heart surgical therapy of in open foramen ovale incarcerated giant thrombus with pulmonary and cerebral embolization. Z Kardiol. 1997;86(9):732–7.CrossRefGoogle Scholar
  10. 10.
    Pavesi PC, Pedone C, Crisci M, Piacentini A, Fulvi M, Di Pasquale G. Concomitant submassive pulmonary embolism and paradoxical embolic stroke after a long flight: which is the optimal treatment? J Cardiovasc Med (Hagerstown). 2008;9(10):1070–3.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2018

Authors and Affiliations

  1. 1.Department of Critical Care MedicineBaystate Medical CenterSpringfieldUSA

Personalised recommendations