A suspected case of paradoxical renal embolism through the patent foramen ovale

We experienced a case of cryptogenic renal infarction in a previously healthy 60-year-old man. He had no systemic atherosclerotic changes. Holter monitoring revealed no atrial fibrillation. Transthoracic echocardiography showed no thrombus. Because the onset occurred while he was swinging a golf club (a similar maneuver to holding the breath), further examination was performed with a view to detecting paradoxical embolism through the foramen ovale. A positive bubble test with the Valsalva maneuver during transesophageal echocardiography led to the diagnosis of patent foramen ovale (PFO). This was a suspected case of paradoxical embolism through a PFO leading to renal infarction.     

A rare case of impending paradoxical embolism with a complex patent foramen ovale

A 68-year-old woman, who presented with pulmonary embolism, was diagnosed as having an impending paradoxical thromboembolism by transthoracic and transesophageal echocardiography, which revealed an entrapped thrombus in the atrial septum. The patient underwent surgery for thromboembolectomy. A patent foramen ovale (PFO) appeared as a tunnel with three openings into the left atrium; one opening located close to the antero-superior left atrial wall and two small atrial septal defects of a septum primum. A thrombus was trapped at two small atrial septal defects. This was a rare case of impending paradoxical embolism with complex morphology of PFO.     

A rare case of acute renal failure--acute bilateral renal artery embolism

Sir, I have carefully read the article concerning bilateral renalartery embolism (RAE) [1], and I would like to make severalremarks. RAE is an underdiagnosed and quite     

A case of renal artery embolism treated with urokinase

Herein we describe a 59-year-old man with left renal artery emboli treated with selective intra-arterial infusion followed by systemic intravenous infusion of urokinase. Total dose of infused urokinase was 2,712,000 units. Although the function of the affected kidney was not recovered, we have demonstrated successful clot lysis and no complication. Selective or systemic thrombolytic therapy is extremely promising as a method of treatment of renal artery embolism, especially in the poor operative candidate. The availability of this potentially efficacious therapy suggests that aggressive diagnostic studies be performed early in patients suspected of having renal artery embolism.     

Impending paradoxical embolism across a patent foramen ovale: case report

We describe a case of impending paradoxical embolism in a 43-year-old male patient with pulmonary embolism. Transesophageal echocardiography revealed a thromboembolus straddling a patent foramen ovale. The patient underwent emergency removal of the intracardiac clot with closure of the patent foramen ovale. A postoperative work-up for a hypercoagulable state revealed a protein-S deficiency and bilateral lower extremity deep vein thromboses. A Greenfield inferior vena cava filter was inserted, anticoagulation was performed, and warfarin treatment was continued after the patient was discharged home.     

A paradoxical air embolism in a closed foramen ovale

This case report deals with a patient who was being operated on for a tumor of the colon and who died from a paradoxical venous air embolism. Accompanying massive blood loss impedes differentiation of hemodynamic disturbances either due to venous air embolism or to hemorrhage, respectively. Air was aspirated from the radial artery catheter that was used for blood-pressure monitoring and for taking blood samples for laboratory analysis. At autopsy, no probe-patent foramen ovale could be demonstrated. The mechanism of air passing from the venous to the systemic circulation in our patient remains speculative; however, mechanical cardiopulmonary reanimation itself with its underlying thoracic pump mechanism has to be considered as contributing to the transport of air from the venous to the arterial side of the circulation.     

骨折继发肾动脉栓塞致肾梗死一例报告

肾动脉栓塞是指肾动脉或其分支被栓子堵塞导致肾脏组织缺血、坏死,由于临床罕见,症状无特异性,容易漏诊和误诊。本例骨折后继发肾动脉栓塞致肾梗死少见报道,现报告如下。临床资料患者,男,37岁,以“车祸致全身多处疼痛伴活动受限9 d”之主诉入院。入院9 d前发生车祸致全身多处疼痛,就诊于当地医院,诊断为全身多发骨折、软组织挫裂伤,给予清创缝合伤口、抗感染、患肢制动等治疗,进一步行CT检查发现“左肾动脉栓塞、肾梗死”,为求进一步治疗转来我院。     

Parameters affecting occurrence of paradoxical air embolism

The effects of different patterns of ventilation and intravascular volume infusion on the occurrence of paradoxical air embolism (PAE) were evaluated in 15 pigs with a surgically created atrial septal defect (ASD). A balloon atrial septostomy was created transvenously in anesthetized pigs (mean diameter 8.6 mm +/- 1 mm). Monitoring included transesophageal echocardiography (TEE) of the right and left heart, ECG, EEG, direct arterial pressure, right and left atrial pressures (RAP and LAP), pulmonary artery pressure, and pulmonary capillary wedge pressure (PCWP). With the animal in a head up tilt, air was infused into the superior vena cava at a rate of 0.27 ml.kg-1.min-1 for 6 min or until PAE was identified on the TEE. Four situations were studied--intermittent positive pressure ventilation (IPPV), intermittent positive pressure ventilation with 10 cm H2O positive end-expiratory pressure (PEEP), spontaneous ventilation, and IPPV following infusion of 500 ml hetastarch. The incidence of PAE was not different in any of the four situations. Release of PEEP resulted in an increase in the amount of PAE or new PAE in nine of 14 animals. PAE occurred both with and without mean RAP exceeding mean LAP and the incidence of PAE was not significantly different based on the atrial pressure gradient. In situations during which the mean LAP remained greater than mean RAP throughout the venous air infusion and PAE occurred, transient reversal of the right to left atrial pressure gradient during a portion of each cardiac cycle was demonstrated.     

Orthodeoxia-platypnea syndrome presenting as paradoxical peripheral embolism

A paradoxical embolus associated with orthodeoxia-platypnea syndrome and intracardiac shunting is extremely uncommon. We present a patient who was found to have a positional change in desaturation after a right pneumonectomy who suffered from gangrene of the right foot and simultaneous deep venous thrombosis of the left arm. Workup revealed a patent foramen ovale as a cause for both the right-to-left shunt and the paradoxical emboli. After percutaneous closure the orthodeoxia resolved. This case highlights the necessity of heightened awareness of this syndrome in case of severe hypoxemia after pneumonectomy and the importance of an occult patent foramen ovale.     

Ongoing paradoxical particulate embolism during megaprosthesis placement

Pulmonary embolism (PE) by solid particles is an infrequent complication encountered during orthopedic procedures. A patent foramen ovale (PFO) allows embolic material into the left-sided circulation, potentially affecting several organs. A case of a 33-year-old woman undergoing total proximal femur resection with megaprosthesis reconstruction is presented. Towards the end of surgery, cement was injected to stabilize the prosthesis. Echodense particulate matter was first seen in the right atrium, subsequently in the right ventricle, and also in significant quantities in the left atrium and ventricle. This was accompanied by significant changes in partial pressure of arterial oxygen. Despite the aforementioned disturbances, hemodynamic stability was observed throughout the event. Postoperative follow-up showed persistent hypoxemia but no other abnormalities. This intriguing case of embolism via particulate material in a patient with PFO during hip replacement surgery allows review of the physiology and pathophysiology of PE phenomena.     

Fatal paradoxical air embolism during liver transplantation

We describe a case of fatal paradoxical coronary air embolism during liver transplantation. The literature on the diagnosis and prophylaxis of paradoxical air embolism during liver transplantation is reviewed and discussed.