Pulmonary embolism and renal artery thrombosis in a patient with patent foramen ovale

Carlo Bova; Rossana Calcaterra; Andrea de Vuono; Francesca Serena Pignataro; Elio Fiaschi

doi:10.23750/abm.v93iS1.12948

Pulmonary embolism and renal artery thrombosis in a patient with patent foramen ovale

Authors

Carlo Bova a:1:{s:5:"en_US";s:27:"Azienda Ospedaliera Cosenza";}
Rossana Calcaterra Azienda Ospedaliera, Cosenza
Andrea de Vuono Azienda Ospedaliera, Cosenza
Francesca Serena Pignataro Azienda Ospedaliera, Cosenza
Elio Fiaschi Azienda Ospedaliera, Cosenza

DOI: https://doi.org/10.23750/abm.v93iS1.12948

Keywords:

paradoxical embolism, pulmonary embolism, renal artery thrombosis

Abstract

Background and aim: Paradoxical embolism is a rare condition in which a thrombus migrates from the venous system to the arterial circulation, usually through a patent foramen ovale (PFO). Pulmonary embolism (PE) and isolated occlusion of one renal artery has been seldom reported. Methods. We describe a case of a 47-year old white man with a one-month history of exertional dyspnea who was admitted to our hospital for severe pain in the right lumbar region. Results. A computed tomography showed PE and a thrombotic occlusion of the right renal artery. A trans-thoracic echocardiogram documented a PFO with right to left shunt. Magnetic resonance imaging of the brain and venous compression ultrasonography of the lower extremities were normal. Therapeutic anticoagulation was started. Conclusions. Pulmonary embolism and thrombotic occlusion of one renal artery is a rare manifestation of paradoxical embolism. Exertional dyspnea is an atypical manifestation of PE and can delay the diagnosis

References

Windecker S, Stortecky S, Meier B. Paradoxical Embolism. J Am Coll Cardiol 2014;64:403–15. doi: 10.1016/j.jacc.2014.04.063.

Konstantinides S, Geibel A, Kasper W, Olschewski M, Blümel L, Just H. Patent foramen ovale is an important predictor of adverse outcome in patients with major pulmonary embolism. Circulation. 1998 May 19;97(19):1946-51. doi: 10.1161/01.cir.97.19.1946.

Le Moigne E, Timsit S, Ben Salem D, Didier R, Jobic Y, Paleiron N, Le Mao R, Joseph T, Hoffmann C, Dion A, Rousset J, Le Gal G, Lacut K, Leroyer C, Mottier D, Couturaud F. Patent Foramen Ovale and Ischemic Stroke in Patients With Pulmonary Embolism: A Prospective Cohort Study. Ann Intern Med. 2019 Jun 4;170(11):756-763. doi: 10.7326/M18-3485. Epub 2019 May 7.

Zhang HL, Liu ZH, Luo Q, Wang Y, Zhao ZH, Xiong CM. Paradoxical embolism: Experiences from a single center. Chronic Dis Transl Med. 2017 Mar 30;3(2):123-128. doi: 10.1016/j.cdtm.2017.02.005. eCollection 2017 Jun 25.

Turkstra F, Kuijer PM, van Beek EJ, Brandjes DP, ten Cate JW, Büller HR. Diagnostic utility of ultrasonography of leg veins in patients suspected of having pulmonary embolism. Ann Intern Med. 1997 May 15;126(10):775-81. doi: 10.7326/0003-4819-126-10-199705150-00005

Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, Huisman MV, Humbert M, Jennings CS, Jiménez D, Kucher N, Lang IM, Lankeit M, Lorusso R, Mazzolai L, Meneveau N, Ní Áinle F, Prandoni P, Pruszczyk P, Righini M, Torbicki A, Van Belle E, Zamorano JL; ESC Scientific Document Group. ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J 2020;41:543-603. doi: 10.1093/eurheartj/ehz405.

Stein PD, Beemath A, Matta F, Weg JG, Yusen RD, Hales CA, Hull RD, Leeper KV Jr, Sostman HD, Tapson VF, Buckley JD, Gottschalk A, Goodman LR, Wakefied TW, Woodard PK.Clinical characteristics of patients with acute pulmonary embolism: data from PIOPED II. Am J Med 2007; 120: 871-9. doi: 10.1016/j.amjmed.2007.03.024.

Mas JL, Derumeaux G, Guillon B, Massardier E, Hosseini H, Mechtouff L, Arquizan C, Béjot Y, Vuillier F, Detante O, Guidoux C, Canaple S, Vaduva C, Dequatre-Ponchelle N, Sibon I, Garnier P, Ferrier A, Timsit S, Robinet-Borgomano E, Sablot D, Lacour JC, Zuber M, Favrole P, Pinel JF, Apoil M, Reiner P, Lefebvre C, Guérin P, Piot C, Rossi R, Dubois-Randé JL, Eicher JC, Meneveau N, Lusson JR, Bertrand B, Schleich JM, Godart F, Thambo JB, Leborgne L, Michel P, Pierard L, Turc G, Barthelet M, Charles-Nelson A, Weimar C, Moulin T, Juliard JM, Chatellier G; CLOSE Investigators. Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke. N Engl J Med. 2017 Sep 14;377(11):1011-1021. doi: 10.1056/NEJMoa1705915.

Carroll JD, Saver JL, Thaler DE, Smalling RW, Berry S, MacDonald LA, Marks DS, Tirschwell DL; RESPECT Investigators. Closure of patent foramen ovale versus medical therapy after cryptogenic stroke. N Engl J Med. 2013 Mar 21;368(12):1092-100. doi: 10.1056/NEJMoa1301440.

Søndergaard L, Kasner SE, Rhodes JF, Andersen G, Iversen HK, Nielsen-Kudsk JE, Settergren M, Sjöstrand C, Roine RO, Hildick-Smith D, Spence JD, Thomassen L; Gore REDUCE Clinical Study Investigators. Patent Foramen Ovale Closure or Antiplatelet Therapy for Cryptogenic Stroke. N Engl J Med. 2017 Sep 14;377(11):1033-1042. doi: 10.1056/NEJMoa1707404.

Kent DM, Dahabreh IJ, Ruthazer R, Furlan AJ, Weimar C, Serena J, Meier B, Mattle HP, Di Angelantonio E, Paciaroni M, Schuchlenz H, Homma S, Lutz JS, Thaler DE. Anticoagulant vs. antiplatelet therapy in patients with cryptogenic stroke and patent foramen ovale: an individual participant data meta-analysis. Eur Heart J. 2015 Sep 14;36(35):2381-9. doi: 10.1093/eurheartj/ehv252. Epub 2015 Jul 3.

Giblett JP, Williams LK, Kyranis S, Shapiro LM, Calvert PA. Patent Foramen Ovale Closure: State of the Art. Interv Cardiol. 2020 Nov 24;15:e15. doi: 10.15420/icr.2019.27. eCollection 2020 Apr.