Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-14T19:17:26.315Z Has data issue: false hasContentIssue false

Paradoxical embolism: a rare life- and limb-threatening emergency

Published online by Cambridge University Press:  21 May 2015

Christine E. Tang*
Affiliation:
Emergency Department, Credit Valley Hospital, Mississauga, Ont
*
Credit Valley Hospital, 2200 Eglinton Ave. West, Mississauga ON L5M 2N1; [email protected]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

This article presents a case of a 43-year-old man with paradoxical embolism. The patient had simultaneous deep venous thrombosis, pulmonary embolism and bilateral limb-threatening arterial occlusions. The unifying diagnosis was paradoxical embolism through a previously undetected atrial septal defect. Suggestions for the evaluation and emergency management of paradoxical embolism are outlined, and the literature is briefly reviewed.

Type
Case Report • Observations De Cas
Copyright
Copyright © Canadian Association of Emergency Physicians 2004

References

1.Mirarchi, FL, Hecker, J, Kramer, CM.Pulmonary embolism complicated by patent foramen ovale and paradoxical embolization. J Emerg Med 2000;19(1)2730.CrossRefGoogle ScholarPubMed
2.Aboyans, V, Lacroix, P, Ostyn, E, Cornu, E, Laskar, M.Diagnosis and management of entrapped embolus through a patent foramen ovale. Eur J Cardiothorac Surg 1998;14(6):6248.CrossRefGoogle ScholarPubMed
3.Cohnheim, J.Thrombose und embolie. Vorl Allg Pathol 1877; 1:1434.Google Scholar
4.Thompson, T, Evans, W.Paradoxical embolism. QJM 1930;23: 13550.Google Scholar
5.Ward, R, Jones, D, Haponik, EF.Paradoxical embolism: an underrecognized problem. Chest 1995;108(2):54958.Google Scholar
6.AbuRahma, AF, Lucente, FC, Boland, JP.Paradoxical embolism: an underestimated entity. A plea for comprehensive work-up. J Cardiovasc Surg 1990;31:68592.Google ScholarPubMed
7.Georgopoulos, SE, Chronopoulos, A, Dervisis, KI, Arvanitis, DP.Paradoxical embolism: an old but, paradoxically, underestimated problem. J Cardiovasc Surg 2001;42(5):6757.Google Scholar
8.Johnson, BI.Paradoxical embolism. J Clin Pathol 1951;4:31632.CrossRefGoogle ScholarPubMed
9.Loscalzo, J.Paradoxical embolism: clinical presentation, diagnostic strategies, and therapeutic options. Am Heart J 1986;112:1415.CrossRefGoogle ScholarPubMed
10.Martin, F, Sanchez, PL, Doherty, E, Colon-Hernandez, PJ, Delgado, G, Inglessis, I, et al. Percutaneous transcatheter closure of patent foramen ovale in patients with paradoxical embolism. Circulation 2002;106(9):11216.CrossRefGoogle ScholarPubMed
11.Meacham, RR 3rd, Headley, S, Bronze, MS, Lewis, JB, Rester, MM.Impending paradoxical embolism. Arch Intern Med 1998; 158(5):43848.CrossRefGoogle ScholarPubMed
12.Cheng, TO.Paradoxical embolism: diagnosis and management. J Emerg Med 2001;20(4):4168.Google Scholar
13.Nacht, A, Kronzon, I.Intracardiac shunts. Crit Care Clin 1996; 12(2):295319.Google Scholar
14.Chen, W, Kuan, P, Lien, W, Lin, F.Detection of patent foramen ovale by contrast transesophageal echocardiography. Chest 1992;101:151520.Google Scholar
15.Jauss, M, Kaps, M, Keberle, M, Haberbosch, W, Dorndorf, W.A comparison of transesophageal echocardiography and transcranial Doppler sonography with contrast medium for detection of patent foramen ovale. Stroke 1994;25:12657.CrossRefGoogle ScholarPubMed
16.Job, FP, Ringelstein, EB, Grafen, Y, Flachskampf, FA, Doherty, C, Stockmanns, A, et al. Comparison of transcranial contrast Doppler sonography and transesophageal contrast echocardiography for the detection of patent forament ovale in young stroke patients. Am J Cardiol 1994;74:3814.CrossRefGoogle ScholarPubMed
17.Hagen, PT, Scholz, DG, Edwards, WD.Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clin Proc 1984;59:1220.Google Scholar
18.Gazzaniga, AB, Dalen, JE.Paradoxical embolism: its pathophysiology and clinical recognition. Ann Surg 1970;171:13742.Google Scholar
19.Leonard, RCF, Neville, E, Hall, RJC.Paradoxical embolism: a review of cases diagnosed during life. Eur Heart J 1982;3:35270.CrossRefGoogle ScholarPubMed
20.Meister, SG, Grossman, W, Dexter, L, Dalen, JE.Paradoxical embolism: diagnosis during life. Am J Med 1972;53:2928.CrossRefGoogle ScholarPubMed
21.Travis, JA, Fuller, SB, Ligush, J, Plonk, GW, Geary, RL, Hansen, KJ.Diagnosis and treatment of paradoxical embolus. J Vasc Surg 2001;34(5):8605.Google Scholar
22.Wongpraparut, N, Zamen, M, Langan, N, Jacobs, L, Kotler, M, Owen, AN.Paradoxical embolism. Echocardiography 2002; 19(1):778.Google Scholar
23.Greenfield, LJ, Proctor, MC.Twenty-year clinical experience with the Greenfield filter. Cardiovasc Surg 1995;3:199205.Google Scholar
24.Chaikof, EL, Campbell, BE, Smith, RB.Paradoxical embolism and acute arterial occlusion: rare or unsuspected? J Vasc Surg 1994;20:37784.Google Scholar
25.Ngaage, DL, Bhamra, GS, Gaynor, S, Nair, UR.Saved by the bell: early surgical treatment for cardiosystemic thromboembolism. J Thorac Surg 2002;123(5):10101.Google Scholar
26.Van Dantzig, JM, Cherieux, EC, Snoep, G, Prenger, KB.Impending paradoxical embolus: clinical imaging and successful surgical treatment. Int J Card Imaging 1998;14(3):16770.Google Scholar
27.Bogousslavsky, J, Garazi, S, Jeanrenaud, X, Aebischer, N, Van Melle, G.Stroke recurrence in patients with patent foramen ovale: the Lausanne Study. Neurology 1996;46:13015.Google Scholar
28.Mas, JL, Zuber, M.Recurrent cerebrovascular events in patients with patent foramen ovale, atrial septal aneurysm, or both and cryptogenic stroke or transient ischemic attack. Am Heart J 1995;130:10838.CrossRefGoogle ScholarPubMed
29.Nendaz, M, Sarasin, FP, Bogousslavsky, J.How to prevent stroke recurrence in patients with patent foramen ovale: anticoagulants, antiaggregants, foramen closure, or nothing? Eur Neurol 1997;37:199204.CrossRefGoogle ScholarPubMed
30.Hung, J, Landzberg, MJ, Jenkins, KJ, King, ME, Lock, JE, Palaciosis, IF, et al. Closure of patent foramen ovale for paradoxical emboli: intermediate-term risk of recurrent neurological events following transcatheter device placement. J Am Coll Cardiol 2000;35(5):13116.Google Scholar
31.Bruch, L, Parsi, A, Grad, MO, Rux, S, Burmeister, T, Krebs, H, et al. Transcatheter closure of interatrial communications for secondary prevention of paradoxical embolism: single-center experience. Circulation 2002;105(24):28458.CrossRefGoogle ScholarPubMed