Patent Foramen Ovale Complicated With Renal Infarction and Pulmonary Embolism: A Case Report With Literature Review

Overview

Journal Cureus

Specialty Biomedical Engineering

Date 2023 Mar 30

PMID 36994257

Authors

Yasuaki Iizuka

Tomoya Tsuchida

Kohei Ashikaga

Kenya Ie

Takuya Matsuda

Kosuke Ishizuka

Chiaki Okuse

Takahide Matsuda

Yoshiyuki Ohira

Affiliations

Soon will be listed here.

Abstract

A 48-year-old man visited our emergency room after experiencing sudden left back pain, diaphoresis, and nausea. The patient underwent physical and laboratory examinations. Physical examination revealed tenderness in the left costovertebral angle. Laboratory examination revealed a slight elevation in D-dimer levels. Contrast-enhanced computed tomography revealed a bilateral pulmonary embolism and left renal infarction. Back pain was resolved following anticoagulation therapy with heparin. Transesophageal echocardiography revealed a patent foramen ovale (PFO). The patient was discharged on an anticoagulant, apixaban. Identifying the cause of paradoxical embolisms, such as an atrial septal defect or PFO, in cases with an arterial embolism in a young patient with no underlying disease is important.

Citing Articles

Paradoxical renal embolization via patent foramen ovale: a case of complicated pulmonary embolism and renal infarction mitigated by accessory renal arteries (Nephrology images).

Stefan G, Badea A, Spataru D, Stancu S J Nephrol. 2023; 36(9):2645-2647.

PMID: 37490270 DOI: 10.1007/s40620-023-01722-9.

References

Park M, Park J, Yun S, Lee J, Kim J, Lee N . A case of cryptogenic stroke associated with patent foramen ovale coexisting with pulmonary embolisms, deep vein thromboses, and renal artery infarctions. Korean Circ J. 2013; 42(12):853-6. PMC: 3539053. DOI: 10.4070/kcj.2012.42.12.853. View

Herbaut A, Mahieux P, Contu E, KAHN R, Askenasi R . Renal infarction caused by paradoxical embolism. Am J Emerg Med. 1985; 3(3):206-7. DOI: 10.1016/0735-6757(85)90090-7. View

Kim J, Seo J, Do K, Ko S, Lee S, Lee J . Paradoxical embolism detected on CT angiography and treated with temporary inferior vena cava filtration and anticoagulation. AJR Am J Roentgenol. 2004; 183(5):1244-6. DOI: 10.2214/ajr.183.5.1831244. View

Schneider B, Zienkiewicz T, Jansen V, Hofmann T, NOLTENIUS H, Meinertz T . Diagnosis of patent foramen ovale by transesophageal echocardiography and correlation with autopsy findings. Am J Cardiol. 1996; 77(14):1202-9. DOI: 10.1016/s0002-9149(96)00163-4. View

Goueffic Y, Carbajal R, Burban M, Blancho G . Successful endovascular treatment of bilateral renal artery paradoxical embolus by a modified standard technique. Nephrol Dial Transplant. 2006; 21(8):2315-7. DOI: 10.1093/ndt/gfl161. View

WARD R, Jones D, Haponik E . Paradoxical embolism. An underrecognized problem. Chest. 1995; 108(2):549-58. DOI: 10.1378/chest.108.2.549. View

Martinez V, Joly L, Troche G, Zazzo J, Fartouk M, Benhamou D . [Severe pulmonary embolism with two indications for inferior vena cava filter placement]. Ann Fr Anesth Reanim. 2000; 19(4):253-6. DOI: 10.1016/s0750-7658(00)00216-1. View

Bernardi E, Camporese G, Buller H, Siragusa S, Imberti D, Berchio A . Serial 2-point ultrasonography plus D-dimer vs whole-leg color-coded Doppler ultrasonography for diagnosing suspected symptomatic deep vein thrombosis: a randomized controlled trial. JAMA. 2008; 300(14):1653-9. DOI: 10.1001/jama.300.14.1653. View

Cluzel P, Enache I, Ballout J, Montoille H, Eicher J . [A case of renal paradoxical embolism]. Nephrol Ther. 2007; 3(2):69-73. DOI: 10.1016/j.nephro.2007.01.002. View

10.

Saver J . CLINICAL PRACTICE. Cryptogenic Stroke. N Engl J Med. 2016; 374(21):2065-74. DOI: 10.1056/NEJMcp1503946. View

11.

Oh Y, Yang C, Kim Y, Kang S, Park C, Kim Y . Clinical Characteristics and Outcomes of Renal Infarction. Am J Kidney Dis. 2015; 67(2):243-50. DOI: 10.1053/j.ajkd.2015.09.019. View

12.

Santangelo G, Ielasi A, Pattarino F, Saino A, Scopelliti P, Tespili M . Pulmonary embolism with migrating thrombus through patent foramen ovale: A case for a mixed pharmacological and percutaneous management. J Cardiol Cases. 2019; 19(1):19-21. PMC: 6342615. DOI: 10.1016/j.jccase.2018.08.007. View

13.

Di Tullio M, Sacco R, Venketasubramanian N, Sherman D, Mohr J, Homma S . Comparison of diagnostic techniques for the detection of a patent foramen ovale in stroke patients. Stroke. 1993; 24(7):1020-4. DOI: 10.1161/01.str.24.7.1020. View

14.

Cheng T . Platypnea-orthodeoxia syndrome: etiology, differential diagnosis, and management. Catheter Cardiovasc Interv. 1999; 47(1):64-6. DOI: 10.1002/(SICI)1522-726X(199905)47:1<64::AID-CCD15>3.0.CO;2-6. View

15.

Windecker S, Stortecky S, Meier B . Paradoxical embolism. J Am Coll Cardiol. 2014; 64(4):403-15. DOI: 10.1016/j.jacc.2014.04.063. View

16.

Lim J, Lau K, Lim A . Successful rescue from kidney failure with delayed catheter-directed intervention after catastrophic bilateral kidney paradoxical thromboembolism. BMJ Case Rep. 2022; 15(2). PMC: 8845175. DOI: 10.1136/bcr-2021-246885. View

17.

Saver J . Cryptogenic stroke in patients with patent foramen ovale. Curr Atheroscler Rep. 2008; 9(4):319-25. DOI: 10.1007/s11883-007-0039-y. View

18.

Jung S, Lee S, Jang H, Cho H, Chang S, Kim H . Bilateral Acute Renal Infarction Due to Paradoxical Embolism in a Patient with Eisenmenger Syndrome and a Ventricular Septal Defect. Intern Med. 2021; 60(24):3937-3940. PMC: 8758438. DOI: 10.2169/internalmedicine.7549-21. View