Paradoxical brain embolism shadowing massive pulmonary embolism |
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Authors: | François Bagate Alexandre Bedet Armand Mekontso Dessap Guillaume Carteaux |
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Affiliation: | AP-HP, CHU Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Créteil, F-94010, France;Université Paris Est Créteil, Faculté de Médecine, Groupe de recherche clinique CARMAS, Créteil, F-94010, France |
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Abstract: | Patent foramen ovale is frequently observed in the general population. In case of massive pulmonary embolism, the sudden increase in the right heart cavity's pressure may cause a right-to-left shunting across this foramen, which could be associated with conflicting outcomes. Herein, we report a case of reversible cardiac arrest preceded by seizures, and followed by hemodynamic stability without any vasopressor. A brain CT-scan showed a limited ischemic stroke. Initial echocardiographic assessment revealed an acute cor pulmonale and a right-to-left intracardiac shunt across a large patent foramen ovale, suggesting the diagnosis of massive pulmonary embolism that was lately confirmed by a multidetector CT-angiography. Anticoagulation therapy was rapidly complicated by a hemorrhagic transformation of the ischemic stroke leading to a fatal outcome. This case illustrates the double-edged circulatory effect of shunting across a patent foramen ovale in case of massive pulmonary embolism: it may have limited circulatory failure but caused in the meanwhile a fatal paradoxical brain embolism. |
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Keywords: | Corresponding author at: Hôpitaux de Paris Groupe Henri Mondor-Albert Chenevier Service de Réanimation Médicale 51 avenue du Maréchal de Lattre de Tassigny 94010 Créteil Cedex France. |
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