Multiple Paradoxical Embolisms Caused by Central Venous Catheter Thrombus Passing Through a Patent Foramen Ovale: A Case Report

Overview

Journal World J Clin Cases

Publisher Baishideng Publishing Group

Specialty General Medicine

Date 2024 Feb 7

PMID 38322689

Authors

Jian-Duan Li

Nian Xu

Qiang Zhao

Biao Li

Li Li

Affiliations

Soon will be listed here.

Abstract

Background: To date, this is the first case of a paradoxical embolism (PDE) that concurrently manifested in the coronary and lower limb arteries and was secondary to a central venous catheter (CVC) thrombus a patent foramen ovale (PFO).

Case Summary: Here, we report a case of simultaneous coronary and lower limb artery embolism in a PFO patient carrier of a CVC. The patient presented to the hospital with acute chest pain and lower limb fatigue. Doppler ultrasound showed a large thrombus in the right internal jugular vein, precisely at the tip of the CVC. Transthoracic and transesophageal echocardiography confirmed the existence of a PFO, with inducible right-to-left shunting by the Valsalva maneuver. The patient was administered an extended course of anticoagulation therapy, and then the CVC was successfully removed. Percutaneous PFO closure was not undertaken. There was no recurrence during follow-up.

Conclusion: Thus, CVC-associated thrombosis is a potential source for multiple PDE in PFO patients.

References

Belkin R, Pollack B, Ruggiero M, Alas L, Tatini U . Comparison of transesophageal and transthoracic echocardiography with contrast and color flow Doppler in the detection of patent foramen ovale. Am Heart J. 1994; 128(3):520-5. DOI: 10.1016/0002-8703(94)90626-2. View

Petrea R, Koyfman F, Pikula A, Romero J, Viereck J, Babikian V . Acute stroke, catheter related venous thrombosis, and paradoxical cerebral embolism: report of two cases. J Neuroimaging. 2011; 23(1):111-4. DOI: 10.1111/j.1552-6569.2010.00568.x. View

Pristipino C, Sievert H, DAscenzo F, Mas J, Meier B, Scacciatella P . European position paper on the management of patients with patent foramen ovale. General approach and left circulation thromboembolism. Eur Heart J. 2018; 40(38):3182-3195. DOI: 10.1093/eurheartj/ehy649. View

Islam M, Khalighi K, Goldstein J, Raso J . Paradoxical embolism-report of a case involving four organ systems. J Emerg Med. 2000; 19(1):31-4. DOI: 10.1016/s0736-4679(00)00178-5. View

Hargreaves M, Maloney D, Gribbin B, Westaby S . Impending paradoxical embolism: a case report and literature review. Eur Heart J. 1994; 15(9):1284-5. DOI: 10.1093/oxfordjournals.eurheartj.a060667. View

Loscalzo J . Paradoxical embolism: clinical presentation, diagnostic strategies, and therapeutic options. Am Heart J. 1986; 112(1):141-5. DOI: 10.1016/0002-8703(86)90692-7. 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

Jacobs B . Central venous catheter occlusion and thrombosis. Crit Care Clin. 2003; 19(3):489-514, ix. DOI: 10.1016/s0749-0704(03)00002-2. View

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

10.

Batsis J, Craici I, Froehling D . Central venous catheter thrombosis complicated by paradoxical embolism in a patient with diabetic ketoacidosis and respiratory failure. Neurocrit Care. 2005; 2(2):185-8. DOI: 10.1385/NCC:2:2:185. View

11.

Garachemani A, Eshtehardi P, Meier B . Paradoxical emboli through the patent foramen ovale as the suspected cause of myocardial and renal infarction in a 48-year-old woman. Catheter Cardiovasc Interv. 2007; 70(7):1010-2. DOI: 10.1002/ccd.21214. View

12.

Citla Sridhar D, Abou-Ismail M, Ahuja S . Central venous catheter-related thrombosis in children and adults. Thromb Res. 2020; 187:103-112. DOI: 10.1016/j.thromres.2020.01.017. View