Iatrogenic Paradoxical Stroke in a Patient With Catheter-Associated Thrombosis and Systemic-to-Pulmonary Venous Shunt.

Lucas J Policastro,Kristaq Koci

doi:10.1177/2324709618813175

Abstract

Paradoxical embolism occurs when thrombotic material traverses a right-to-left shunt. We describe the first case of paradoxical stroke resulting from manipulation of a disused chemotherapy port. Contrast studies revealed that the mechanism was systemic-to-pulmonary venous shunt, in which systemic veins drain into the left atrium via collaterals. Chronically thrombosed central venous catheters may result in venous stenosis and shunt formation, exposing patients to risks of paradoxical stroke, acute coronary syndrome, hypoxemia, and other complications. This case highlights the life-threatening complications that may result from neglect of an implantable central venous catheter. Preventative measures are to promptly recognize and treat catheter-related thrombosis and to remove unneeded catheters.

Highlights

Paradoxical embolism refers to arterial embolism resulting from thrombotic material of venous origin
Catheter-associated thrombosis is a frequent complication of long-term indwelling central venous catheters (CVCs)[1] and may result in right-toleft shunt formation
Systemic-to-pulmonary venous shunt (SPVS) is a rarely reported type of right-to-left shunt, in which systemic veins drain into the pulmonary veins or left atrium.[2,3]

Summary

Introduction

Paradoxical embolism refers to arterial embolism resulting from thrombotic material of venous origin. Catheter-associated thrombosis is a frequent complication of long-term indwelling central venous catheters (CVCs)[1] and may result in right-toleft shunt formation.

Results

Conclusion