Cases reported "Embolism, Paradoxical"

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1/108. Paradoxical air embolism during orthoptic liver transplantation: diagnosis by transoesophageal echocardiography.

    We describe a case of paradoxical air embolism during orthotopic liver transplantation, early diagnosis, using intra-operative transoesophageal echocardiography after a circulatory failure, allowed early management by hyperbaric oxygen therapy. ( info)

2/108. Patent foramen ovale as a potential cause of paradoxical embolism in the postpartum period.

    We report a case of previously healthy woman who suffered cerebral embolism after delivery. echocardiography with contrast medium confirmed the patent foramen ovale (PFO). PFO may be a mechanism of paradoxical embolism causing a transient ischemic attack or stroke. ( info)

3/108. Inverse paradoxical embolism in a patient on chronic hemodialysis with aortic bacterial endocarditis.

    We present a 45-year-old patient on chronic hemodialysis who suffered aortic endocarditis by staphylococcus haemolyticus after bacteremia associated with a venous catheter, which was used temporarily during the maturing phase of a Cimino-Brescia arteriovenous fistula in the left forearm. Three weeks after starting antibiotic therapy, the patient suffered a septic pulmonary embolism. The catheter had been removed 4 weeks before the embolism. thrombophlebitis of lower limbs, infection or thrombosis of the vascular access, and the involvement of right-sided cardiac structures were all discarded. We assumed that the pulmonary episode was probably a consequence of the paradoxical passage of embolic material, detached from the aortic valve, from arterial to venous circulation through the arteriovenous fistula. ( info)

4/108. Cerebral embolism after mechanical thrombolysis of a clotted hemodialysis access.

    Clinically significant embolic complications after thrombolysis of clotted hemodialysis grafts are uncommon. Most of the concern has focused on the risks associated with pulmonary emboli. We report a case of a hemodialysis patient who developed a cerebral embolism after percutaneous graft thrombolysis who was found to have a patent foramen ovale and intermittent right-to-left shunt. ( info)

5/108. Bilateral renal infarction secondary to paradoxical embolism.

    Paradoxical embolism is an uncommon but increasingly reported cause of arterial embolic events. Involvement of the kidney is rarely reported. autopsy studies suggest, however, that embolic renal infarction is underdiagnosed antemortem. We report a case of bilateral, main renal artery occlusion and acute renal failure secondary to paradoxical embolism. Clinical and laboratory data at presentation were not suggestive of renal infarction. Support for the diagnosis of paradoxical embolism, which most commonly occurs across a patent foramen ovale, was made by contrast echocardiography, which provides a sensitive method for detecting right-to-left intracardiac shunts. The often subtle presentation of renal infarction suggests patients with peripheral or central arterial embolic events should be carefully observed for occult renal involvement. Contrast echocardiography should be performed when renal infarction occurs without a clear embolic source to evaluate for paradoxical embolism. ( info)

6/108. Paradoxical embolism in a boy with cystic fibrosis and a stroke.

    An 11 year old boy with cystic fibrosis suffered a stroke, producing right sided weakness. Four years previously a totally implantable venous access device (Port-a-Cath) had been inserted. magnetic resonance angiography revealed a filling defect in the left middle cerebral artery. Transoesophageal echocardiography demonstrated a thrombus attached to the tip of the Port-a-Cath and also the presence of a patent foramen ovale. After an initial period of anticoagulation the defect was closed using a septal occlusion device introduced via a cardiac catheter. The boy's neurological signs completely resolved and he remains free from further thromboembolic episodes. Whilst pulmonary embolism has been described before in relation to a totally implantable venous access device, this is believed to be the first description of a paradoxical embolism in relation to such a device. ( info)

7/108. Transcranial Doppler of a paradoxical brain embolism associated with a pulmonary arteriovenous fistula.

    We herein report the case of a patient who had paradoxical brain embolism owing to a pulmonary arteriovenous fistula (PAVF) who was diagnosed as having a right-to-left shunt by transcranial Doppler (TCD) with saline contrast medium. TCD with saline contrast medium failed to detect any high-intensity transient signals immediately after catheter embolization of the PAVF. Thus, TCD with saline contrast medium was useful for identifying the presence of a right-to-left shunt and for confirming that the shunt had been obliterated after endovascular treatment. ( info)

8/108. Paradoxical emboli: demonstration using helical computed tomography of the pulmonary artery associated with abdominal computed tomography.

    We report the case of a 60-year-old woman with a recent history of a cerebrovascular accident. Because of clinical suspicion of pulmonary embolism and negative Doppler ultrasound findings of the lower limbs, spiral computed tomography of the pulmonary artery was performed and demonstrated pulmonary emboli. We emphasize the role of computed tomography of the abdomen, performed 3 min after the thoracic acquisition, which showed an unsuspected thrombus within the abdominal aorta and the left renal artery with infarction of the left kidney. Paradoxical embolism was highly suspected on computed tomography data and confirmed by echocardiography which demonstrated a patent foramen ovale. ( info)

9/108. Septic paradoxical embolus through a patent foramen ovale after pacemaker implantation.

    A case of a septic paradoxic embolus due to an infected pacemaker lead associated with a patent foramen ovale (PFO) is described. Treatment consisted of immediate intracardiac embolectomy, pericardial patch closure of the PFO, total removal of the infected pacemaker lead and generator, and placement of a new permanent epicardial lead pacemaker system. ( info)

10/108. A case of acute pulmonary embolism and acute myocardial infarction with suspected paradoxical embolism after laparoscopic surgery.

    We describe the case of a 59-year-old Japanese man who had an acute pulmonary embolism in addition to acute myocardial infarction after a laparoscopic cholecystectomy. The posterior descending coronary artery was totally occluded. and direct percutaneous transluminal balloon angioplasty was performed. The pulmonary embolism was diagnosed by lung perfusion scanning and was treated with anticoagulant therapy. A patent foramen ovale and right-to-left atrial shunting of blood were detected by contrast transesophageal echocardiography. Paradoxical embolism is a rare complication of pulmonary embolism and may have been responsible for the acute myocardial infarction in our patient. ( info)
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