Paradoxical Brain Embolism Caused by Pulmonary Arteriovenous Fistula

Abstract

We report here a case of special paradoxical brain embolism in a 40-year-old woman with neurological events who was diagnosed with medulla oblongata infarction. Contrast-enhanced pulmonary CT discovered that the patient had a pulmonary arteriovenous fistula (PAVF). The PAVF was later surgically resected. We conclude that if a patent foramen ovale cannot be confirmed by echocardiography, contrast-enhanced pulmonary CT scan could prove to be a helpful tool to detect another origin of a right-to-left shunt such as pulmonary arteriovenous fistula.

Key words

Pulmonary arteriovenous fistula - paradoxical brain embolism - contrast‐enhanced CT

References

• 1 Barter T, Irwin R S, Nash G. Aneurysms of the pulmonary arteries.  Chest. 1988;  94 1065
• 2 Mirachi F L, Hecker J, Kramer C M. Pulmonary embolism complicated by patent foramen ovale and paradoxical embolization.  J Emerg Med. 2000;  19 27-30
• 3 Ialam M A, Khalighi K, Jeffrey E et al. Paradoxical embolism – report of a case involving four organ systems.  J Emerg Med. 2000;  19 31-34
• 4 Oliveira G H, Seward J B, Stanson A W et al. Paradoxical cerebrovascular embolism associated with pulmonary arteriovenous fistula: contrast transoesophageal echocardiographic diagnosis.  Eur J Echocardiogr. 2001;  2 207-211
• 5 Pick A, Deschamps C. Pulmonary arteriovenous fistula: presentation, diagnosis, and treatment.  World J Surg. 1993;  23 1118-1122
• 6 Remy-Jardin M, Dumont P, Brill P-Y et al. Pulmonary arteriovenous malformations treated with embolotherapy: helical CT evaluation of long-term effectiveness after 2–21-year follow-up.  Radiology. 2006;  239 576-585