2,436 results match your criteria Paradoxical Embolism


Paradoxical venous air embolism detected with point-of-care ultrasound: a case report.

Ultrasound J 2022 May 18;14(1):19. Epub 2022 May 18.

Cuidado Crítico, Hospital Universitario Nacional de Colombia, Bogotá D.C, Colombia.

Venous air embolism (VAE) is an uncommon event consistent in the entrainment of air from any communication between the environment and the venous vasculature that could occur during central venous catheter (CVC) manipulation, and might trigger circulatory shock within minutes depending on the amount of air embolized. We present a case of a critical care patient who presented sudden clinical hemodynamic deterioration after the removal of central venous catheter. Hemodynamic evaluation with point-of-care ultrasound (POCUS) showed bubbles in both right and left heart cavities wherewith air embolism facilitated by heart septal defect was suspected. Read More

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Current Challenges and Future Directions in Handling Stroke Patients With Patent Foramen Ovale-A Brief Review.

Front Neurol 2022 28;13:855656. Epub 2022 Apr 28.

Department of Neurology, University of Leipzig, Leipzig, Germany.

The role of patent foramen ovale (PFO) in stroke was debated for decades. Randomized clinical trials (RCTs) have shown fewer recurrent events after PFO closure in patients with cryptogenic stroke (CS). However, in clinical practice, treating stroke patients with coexisting PFO raises some questions. Read More

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Hereditary Hemorrhagic Telangiectasia and Arterio-Venous Malformations-From Diagnosis to Therapeutic Challenges.

J Clin Med 2022 May 7;11(9). Epub 2022 May 7.

Sf. Spiridon Emergency Hospital, 700111 Iași, Romania.

Hereditary hemorrhagic telangiectasia is a rare autosomal dominant vascular disease defined by the presence of mucosal and cutaneous telangiectasia and visceral arterio-venous malformations. The latter are abnormal capillary-free direct communications between the pulmonary and systemic circulations with the following consequences: arterial hypoxemia caused by right-to-left shunts; paradoxical embolism with transient ischemic attack or stroke and brain abscess caused by the absence of the normally filtering capillary bed; and hemoptysis or hemothorax due to the rupture of the thin-walled arterio-venous malformations (particularly during pregnancy). It is frequently underdiagnosed, commonly presenting as complications from shunting through arterio-venous malformations: dyspnea, chronic bleeding, or embolism. Read More

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Microvascular injuries, secondary edema, and inconsistencies in lung vascularization between affected and nonaffected pulmonary segments of non-critically ill hospitalized COVID-19 patients presenting with clinical deterioration.

Ther Adv Respir Dis 2022 Jan-Dec;16:17534666221096040

Nuclear Medicine Department, Centre Hospitalier Princesse Grace, Avenue Pasteur, BP 480, 98012 Monaco, Monaco.

Purpose: We aimed to better understand the pathophysiology of SARS-CoV-2 pneumonia in non-critically ill hospitalized patients secondarily presenting with clinical deterioration and increase in oxygen requirement without any identified worsening factors.

Methods: We consecutively enrolled patients without clinical or biological evidence for superinfection, without left ventricular dysfunction and for whom a pulmonary embolism was discarded by computed tomography (CT) pulmonary angiography. We investigated lung ventilation and perfusion (LVP) by LVP scintigraphy, and, 24 h later, left and right ventricular function by Tc-99m-labeled albumin-gated blood-pool scintigraphy with late (60 mn) tomographic albumin images on the lungs to evaluate lung albumin retention that could indicate microvascular injuries with secondary edema. Read More

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Complete occlusion of the left pulmonary artery and paradoxical cerebral embolus from tricuspid valve endocarditis.

BMJ Case Rep 2022 04 25;15(4). Epub 2022 Apr 25.

Internal Medicine, Oregon Health & Science University, Portland, Oregon, USA.

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Echocardiography findings in COVID-19 patients admitted to intensive care units: a multi-national observational study (the ECHO-COVID study).

Intensive Care Med 2022 Apr 21. Epub 2022 Apr 21.

Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, 92100, Boulogne-Billancourt, France.

Purpose: Severely ill patients affected by coronavirus disease 2019 (COVID-19) develop circulatory failure. We aimed to report patterns of left and right ventricular dysfunction in the first echocardiography following admission to intensive care unit (ICU).

Methods: Retrospective, descriptive study that collected echocardiographic and clinical information from severely ill COVID-19 patients admitted to 14 ICUs in 8 countries. Read More

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Paradoxical carbon dioxide embolism during laparoscopic hepatectomy without intracardiac shunt: A case report.

World J Clin Cases 2022 Mar;10(9):2908-2915

Department of Anesthesia and Pain Medicine, Pusan National University, School of Medicine, Busan 49241, South Korea.

Background: Laparoscopic hepatectomy has recently become popular because it results in less bleeding than open hepatectomy. However, CO embolism occurs more frequently. Most CO embolisms during laparoscopic surgery are self-resolving and non-symptomatic; however, severe CO embolism may cause hypotension, cyanosis, arrhythmia, and cardiovascular collapse. Read More

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Embolic Stroke in Setting of Iliac Vein Stenosis in an Avid Cyclist.

Neurohospitalist 2022 Apr 20;12(2):413-416. Epub 2022 Feb 20.

Department of Neurology, Mayo Clinic College of Medicine and Science, Scottsdale, AZ, USA.

External iliac vein stenosis related to cycling has rarely been reported as a cause of deep vein thrombosis. Ischemic stroke occurring in this condition due to paradoxical embolism across a preexisting patent foramen ovale (PFO) has yet to be reported. Here we report a case of embolic ischemic strokes in a young, avid cyclist with no prior known vascular risk factors. Read More

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Amplatzer Patent Foramen Ovale Occluder Device-Related Complications.

Cureus 2022 Apr 2;14(4):e23756. Epub 2022 Apr 2.

Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.

Patent foramen ovale (PFO) is a standard variant that is present in 25% of the whole adult population. In a certain population, PFO can lead to cerebrovascular accidents. Mechanism of cerebrovascular accidents can be by paradoxical embolization from the right circulation or in situ thrombosis. Read More

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Fat Embolism Syndrome With Cerebral Involvement: An Underrecognized Complication of Long Bone Fractures.

Cureus 2022 Mar 3;14(3):e22816. Epub 2022 Mar 3.

Pulmonary and Critical Care, University of Nebraska Medical Center, Omaha, USA.

Fat embolism syndrome (FES) occurs when fat particles are aberrantly distributed into the microcirculation, and it often manifests as either hypoxemia, neurological deficit, or petechial rash. Although cases have been reported in the literature since the twentieth century, no formal diagnostic criteria have been universally adopted, and FES remains a diagnostic challenge. We present a unique case of FES from a long bone fracture, leading to pulmonary embolism with paradoxical arterial embolization and cerebral infarction, and provide a review of the related literature. Read More

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Ischemic stroke due to sporadic and genetic pulmonary arteriovenous malformations: Case report.

Brain Circ 2022 Jan-Mar;8(1):57-60. Epub 2022 Mar 21.

Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.

Pulmonary arteriovenous malformations (PAVMs) encompass congenital and genetic vascular anomalies characterized by complex interlacing of arteries and veins connected by fistulas, which allow rapid and continuous extracardiac right-to-left shunting (RLS). Presenting neurologic manifestations of PAVM include brain abscess and stroke, as the consequence of paradoxical embolism. Although rare, PAVM represents an overlooked cause of cryptogenic ischemic stroke in young adults, being misdiagnosed as patent foramen ovale and a preventable trigger of silent cerebral ischemic changes. Read More

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Recurrent vertebrobasilar strokes and transient-ischemic attacks with challenging workup: Case report.

Brain Circ 2022 Jan-Mar;8(1):50-56. Epub 2022 Mar 21.

Department of Neurology, University of Regensburg, Medbo Bezirksklinikum Regensburg, Landshut 84034, Germany.

Detecting the stroke etiology in young patients can be challenging. Among others, determining causality between ischemic stroke and patent foramen ovale (PFO) remains a complicated task for stroke neurologists, given the relatively high prevalence of PFOs. Thorough diagnostic workup to identify incidental vascular risk factors and rare embolic sources is crucial to avoid premature PFO closure suggesting successful secondary stroke prevention. Read More

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Case Report: Residual Atrial Shunt Lesions in Aging Adults With Congenital Heart Disease: An Underestimated Risk of Stroke?

Front Cardiovasc Med 2022 16;9:847244. Epub 2022 Mar 16.

Department of Internal Medicine and Cardiology, Charité Universitätsmedizin Berlin, Berlin, Germany.

We report two cases of paradoxical cerebral embolism in adults with congenital heart disease (ACHD) with residual atrial shunt lesions, a 59 year-old male patient with partial detachment of a surgical ASD closure patch, and a 57 year-old male patient with Ebstein's anomaly and a large patent foramen ovale. Considering these mechanisms and the increasing incidence of venous thrombosis with age, a higher prevalence of paradoxical embolism in ACHD patients with residual atrial shunts may be suspected. Regular follow-up of patients with ACHD remains important throughout life even in seemingly stable lesions. Read More

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Endovascular Intervention for May-Thurner Syndrome in a Pregnant Patient with a Patent Foramen Ovale and Paradoxical Embolism.

Vasc Endovascular Surg 2022 Mar 31:15385744221086135. Epub 2022 Mar 31.

Division of Vascular Surgery, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

May-Thurner syndrome (MTS) is a known structural risk factor for deep vein thrombosis (DVT) and embolism. In patients with a patent foramen ovale (PFO), emboli originating from the deep veins are able to paradoxically reach the systemic circulation via the PFO, consequently resulting in transient ischemic attacks (TIA) or stroke.We report the case of a 31-year-old pregnant woman, with a recent history of TIA, who presented with chronic bilateral numbness, pain, and swelling in the lower extremities. Read More

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Cryptogenic Ischemic Stroke in Migraine: Role of Patent Foramen Ovale.

Front Pain Res (Lausanne) 2022 25;3:823595. Epub 2022 Feb 25.

Department of Neurology, University Hospital of Toulouse, Toulouse, France.

Introduction: Migraine with aura (MWA) has been associated with cryptogenic ischemic stroke (CIS) after adjustment for the presence of a patent foramen ovale (PFO) assessed by a transcranial Doppler. This study aimed at evaluating the association of MWA with causal PFO assessed by Transesophageal echocardiography (TEE) in CIS.

Methods: Patients aged 18-54 years consecutively treated for first acute ischemic stroke in a university hospital stroke unit, between January 2017 and December 2019, were included in this cross-sectional study. Read More

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February 2022

Acute neurological deficit with submassive pulmonary emboli.

BMJ Case Rep 2022 Mar 15;15(3). Epub 2022 Mar 15.

Royal Berkshire NHS Foundation Trust, Reading, UK.

Pulmonary embolism (PE) is frequently encountered in the emergency department. Syncope, often as a consequence of impending haemodynamic collapse, is associated with increased mortality. While loss of consciousness owing to cerebral hypoperfusion and reduced left ventricular preload is a common cause of collapse with large volume PE, other syndromes can also cause neurological deficit in thromboembolic disease. Read More

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Nutrition status, obesity and outcomes in patients with atrial fibrillation.

Rev Esp Cardiol (Engl Ed) 2022 Mar 9. Epub 2022 Mar 9.

Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain; Grupo de Investigación Cardiovascular, Instituto de Investigación Sanitaria Galicia Sur, Vigo, Pontevedra, Spain.

Introduction And Objectives: A paradoxical protective effect of obesity has been previously reported in patients with atrial fibrillation (AF). The aim of this study was to determine the impact of nutritional status and body mass index (BMI) on the prognosis of AF patients.

Methods: We conducted a retrospective population-based cohort study of patients with AF from 2014 to 2017 from a single health area in Spain. Read More

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Intracardiac versus extracardiac shunt in a young man with ischaemic stroke.

BMJ Case Rep 2022 Mar 8;15(3). Epub 2022 Mar 8.

Pediatric Cardiology Department and Reference Center for Congenital Heart Diseases, Centro Hospitalar de Lisboa Ocidental EPE Hospital de Santa Cruz, Lisboa, Portugal.

A 24-year-old man with a history of recent ischaemic stroke was diagnosed with patent foramen ovale (PFO) and referred for closure at our hospital. At admission, besides low peripheral oxygen saturation (88%), physical examination was otherwise normal. We performed intraprocedural transoesophageal echocardiogram that revealed no PFO, although agitated saline injection demonstrated bubbles lately on the left atrium. Read More

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Acromegaly Initially Presenting with Severe Infectious Diseases: A Case Report.

JMA J 2022 Jan 24;5(1):161-166. Epub 2021 Dec 24.

Department of Respiratory Medicine, Ishikiri-Seiki Hospital, Higashi-Osaka, Japan.

A 39-year-old man presented with worsening fever, cough, and fatigue. He was immediately admitted to the intensive care unit (ICU) and was found to have sepsis, septic pulmonary embolism, right empyema, liver abscess, pyelonephritis, and a prostate abscess, with background diabetes mellitus. While receiving treatment, an ICU nurse noticed that the patient's toe tips were too large to fit the clamp device of pulse oximeters. Read More

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January 2022

Percutaneous Patent Foramen Ovale Closure in Patients with Cryptogenic Stroke or Transient Ischemic Attack: A Retrospective Study.

Biomed Res Int 2022 30;2022:2614225. Epub 2022 Jan 30.

Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China.

Background: Patent foramen ovale (PFO) is associated with cryptogenic stroke (CS). Transcatheter closure of PFO is superior to pharmacotherapy for patients with CS or transient ischemic attack (TIA). More evidence is needed to evaluate the efficacy and safety of PFO closure in Chinese patients. Read More

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Cardiac magnetic resonance imaging unmasks presumed embolic myocardial infarction due to patent foramen ovale case report.

Eur Heart J Case Rep 2022 Feb 1;6(2):ytac029. Epub 2022 Feb 1.

Department of Cardiology, Royal Brompton and Harefield Hospitals, Guys' and St Thomas NHS Trust.

Background: Occurrence of paradoxical coronary embolism is reported in up to 10-15% of all myocardial infarctions but embolic infarctions presumed to be as a result of a patent foramen ovale (PFO) are rare. Although rare, it is important to identify these patients as they need appropriate investigations to confirm their diagnosis and guide further treatment.

Case Summary: We present the case of a gentleman with troponin positive chest pain with non-obstructed coronaries on invasive coronary angiogram. Read More

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February 2022

Bilateral Intracardiac Microbubbles in a Patient With Giant Hiatus Hernia: A Case Report.

Cureus 2022 Jan 4;14(1):e20933. Epub 2022 Jan 4.

Community Medicine Management, Shimane University Faculty of Medicine, Izumo, JPN.

Intracardiac microbubbles may occur inadvertently during a cardiac procedure, which are typically reported in patients with central venous catheters or cardiac prosthetic valves. Here, we report a case wherein a microbubble filling in the bilateral atriums and ventricles was revealed during echocardiography despite the patient not having the aforementioned risks. An 87-year-old man with hypertension was admitted with a diagnosis of heart failure caused by a giant hiatal hernia. Read More

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January 2022

Successful rescue from kidney failure with delayed catheter-directed intervention after catastrophic bilateral kidney paradoxical thromboembolism.

BMJ Case Rep 2022 Feb 10;15(2). Epub 2022 Feb 10.

Medicine, Monash University School of Clinical Sciences at Monash Health, Clayton, Victoria, Australia

A 62-year-old man presented with acute abdominal and flank pain, oligoanuria and severe acute kidney injury. Unenhanced CT imaging did not detect urolithiasis or hydronephrosis. There was an early blood pressure surge followed by an intense inflammatory response, with a rise in peripheral blood leucocytes and C reactive protein. Read More

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February 2022

[Thalamic infarction following paradoxical embolism during total hip replacement : Case report and pathophysiological considerations].

Anaesthesist 2022 Feb 8. Epub 2022 Feb 8.

Faculty of Medicine, Vilnius University, Vilnius, Litauen.

Because of a painful right-sided coxarthrosis a 57-year-old female patient underwent a cementless total arthroplasty under general anesthesia. Except for Asperger's syndrome and an occlusion of a vein in her left eye she stated no other diseases or complaints, especially no cardiac problems. Postoperatively she developed neurological symptoms of left-sided hemiparesis and hemihypesthesia. Read More

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February 2022

Simultaneously Occurring Ischemic Stroke, Leg Artery Occlusion, and Pulmonary Embolism Induced by a Uterine Myoma.

J Stroke Cerebrovasc Dis 2022 Apr 2;31(4):106328. Epub 2022 Feb 2.

Department of Neurology, National Health Insurance Service Ilsan Hospital, Korea. Electronic address:

Objectives: Paradoxical embolism from venous thrombosis through the patent foramen ovale is a rare but well-known cause of stroke in young adults. Here, we report a case of simultaneous middle cerebral artery infarction, multiple occlusions of the leg arteries, and pulmonary thromboembolism from the venous thrombus, all due to compression of the external iliac vein by a uterine leiomyoma.

Materials And Methods (case Presentation): A 44-year-old woman presented with left hemiparesis and central-type left facial palsy. Read More

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Paradoxical Cerebral Air Embolism after Cardiac Ablation in Williams-Beuren Syndrome: A Clinico-Pathological Correlation.

J Stroke Cerebrovasc Dis 2022 Apr 2;31(4):106317. Epub 2022 Feb 2.

Department of Neurology, Kentucky Neuroscience Institute. Electronic address:

Non-traumatic neurological deterioration is a medical emergency that may arise from diverse causes, to include cerebral infarction or intracranial hemorrhage, meningoencephalitis, seizure, hypoxic-ischemic or toxic/metabolic encephalopathy, poisoning, or drug intoxication. We describe the abrupt onset of neurological deterioration in a 53-year-old man with Williams-Beuren syndrome, a sporadically occurring genetic disorder caused by chromosomal microdeletion at 7q11.23. Read More

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Orientation of the Atrial Septum to the Inferior Vena Cava May Contribute to the Persistent Patency of the Foramen Ovale.

Cardiology 2022 24;147(2):169-178. Epub 2022 Jan 24.

Department of Clinical Physiology and Nuclear Medicine, HUS Medical Imaging Center, Helsinki, Finland.

Purpose: There is growing evidence that paradoxical embolism through patent foramen ovale (PFO) is a cause for cryptogenic stroke. However, it is still unclear why the foramen ovale fails to close after birth. We studied whether the 3D relations between the atrial septum (AS) and the inferior vena cava (IVC) are associated with PFO. Read More

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Suspected cerebrovascular air embolism during endoscopic esophageal varices ligation under sedation with fatal outcome: A case report.

World J Clin Cases 2022 Jan;10(1):371-380

Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.

Background: Air embolism is a very rare, yet serious and potentially fatal complication of digestive endoscopic treatment. Air embolism is the result of air directly entering the arteries or veins. However, to recognize neurological dysfunction under sedation can be difficult. Read More

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January 2022

Concomitant pulmonary and neurological embolisation in a Down patient after SARS-CoV-2 vaccine: what is missing?

Cardiol Young 2022 Jan 24:1-3. Epub 2022 Jan 24.

Department of Cardiology, Fabrizio Spaziani Hospital, Frosinone, Italy.

A 40-year-old Down patient without previous cardiological history was admitted to our institution for dyspnoea after COVID-19 vaccine. CT scan revealed a pulmonary thromboembolism. One week later, he developed neurological impairment and CT scan evidenced a left parietal ischaemic lesion. Read More

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January 2022

Stroke and Respiratory Failure: Mind the Shunt!

Eur J Case Rep Intern Med 2021 16;8(12):003094. Epub 2021 Dec 16.

Centro Hospitalar e Universitário do Porto, Porto, Portugal.

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. Read More

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December 2021