Renal paradoxical embolism in a hypertensive young adult without acute ischemic symptoms

Nara, Mizuho; Komatsuda, Atsushi; Fujishima, Masumi; Fujishima, Naohito; Nara, Miho; Iino, Takako; Itoh, Hiroshi; Sawada, Kenichi; Wakui, Hideki

doi:10.1007/s10157-011-0436-y

Cited by 6 publications

(5 citation statements)

References 9 publications

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“…Such cases accounted for only 2.9% of the referrals to a specialised centre for the evaluation of PFO 5. Such diverse and relatively rarer presentations include acute limb ischaemia,4 6 7 renal infarction,8 9 ischaemia of the digestive tract10 and also myocardial infarction 11 12. Knobloch et al 13 reported a similar case in a young man with myocardial infarction, popliteal artery occlusion and carotid thrombus.…”

Section: Discussionmentioning

confidence: 99%

A unique presentation of four thrombotic events at a time

et al. 2012

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A 72-year-old man was referred to our hospital as a case of postcardiac arrest following a long distance air flight. Work-up in the emergency department revealed the presence of deep vein thrombosis (DVT), bilateral pulmonary embolism, inferior STEMI (ST elevation myocardial infarction) and ischaemic stroke. He received thrombolysis by recombinant tissue plasminogen activator (tPA) following which his haemodynamic status improved, but he developed haemorrhagic transformation of the stroke as a complication. The haemorrhagic lesion gradually resolved with conservative management, leaving behind a residual neurological deficit. His haemodynamic status was stable after the management. Although a diagnosis of right-to-left shunt lesion was highly suggestive in this condition, it could not be confirmed on the transthoracic echocardiogram. Our patient had a unique presentation of multiple thrombi in different organs that caused significant morbidity and haemodynamic instability. There are no well-established guidelines that discuss the acute management of such cases. This situation requires a careful assessment and management of the patient by a multidisciplinary team.

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Section: Discussionmentioning

confidence: 99%

A unique presentation of four thrombotic events at a time

et al. 2012

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“…18 There are a few small studies and case reports that have reported paradoxical embolism to the non-cerebral circulation causing limb ischemia, splanchnic ischemia, and splenic or renal infarction. [19][20][21][22][23][24][25][26][27][28] Almost exclusively the case reports suggest suspected the base ≥15 mm and an excursion with an amplitude ≥15 mm. A PFO was defined as the appearance of microbubbles across the interatrial septum (with or without the Valsalva maneuver) after intravenous contrast injection and the absence of a color Doppler jet, indicating a left-toright shunt.…”

Section: Retrospective and Prospective Studiesmentioning

confidence: 99%

Epidemiology of Myocardial Infarction Caused by Presumed Paradoxical Embolism via a Patent Foramen Ovale

Kleber

Hauschild

Schulz

et al. 2017

Circ J

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paradoxical embolism as the reason for acute myocardial infarction (AMI) in patients with PFO and normal coronary arteries. 26,28-47 Even fatal outcomes have been convincingly published. 48,49 However, to date there has not been a large scale evaluation of this phenomenon. MethodsOur approach to describing the epidemiology of AMI included a retrospective and a prospective study. We retrospectively analyzed the incidence over 10 years of paradoxical coronary embolism in a tertiary care center and then prospectively undertook an effort to prove this using the same criteria over 39 months in another tertiary care center. Retrospective and Prospective StudiesFor the retrospective study, we searched the database of the hospital's information system over a period of 10 years for cases of MI according to the International Classification of Diseases, searching for AMI, recurrent MI, and acute as well as silent ischemia. Subsequently all angiogram A patent foramen ovale (PFO) is caused by defective fusion of the septum primum coverage of the fossa ovalis area after birth. A PFO is present in approximately 25% of the general population. 1 In most cases it never leads to any health issues, but PFO has been recognized as a possible source of paradoxical (venoarterial) embolism since the late 18 th century, 2 especially in patients with additional risk factors such as large right-to-left shunt, 3 atrial septal aneurysm, 4-7 thrombophilia 8-11 or prominent Eustachian valve. 12 A possible mechanism for PFO-related systemic embolic events is paradoxical embolism from the peripheral venous system 13-17 through the interatrial communication to the systemic circulation. The embolisms have a preference to be transmitted to vascular areas in accordance with the anatomy and the centrifugal force (i.e., primarily into the cerebral arteries and there to the posterior vessels). 18 There are a few small studies and case reports that have reported paradoxical embolism to the non-cerebral circulation causing limb ischemia, splanchnic ischemia, and splenic or renal infarction. 19-28Almost exclusively the case reports suggest suspected Background: Despite several negative prospective randomized trials on the efficacy of patent foramen ovale (PFO) occlusion, the discussion on indications is ongoing. Because the incidence of paradoxical coronary embolism through a PFO is unknown, we investigated the risk of paradoxical embolic myocardial infarction over a period of 13 years.

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“…Post-operative pain from renal infarction has been recently reported, but in this case arose from thrombus formation in a resected pulmonary vein stump and hence, not a true paradoxical emboli [6]. Only a limited number of paradoxical renal emboli have been reported and usually present as spontaneous, not post-operative, abdominal pain [7], [8], [9]. PFO occurs in 25–35% of the population and is usually asymptomatic but can cause cryptogenic stroke, migraine, platypnea-orthodeoxia syndrome and air embolism during decompression sickness in divers [10].…”

Section: Discussionmentioning

confidence: 73%