Cor Vasa 2023, 65(4):715-717 | DOI: 10.33678/cor.2022.135
A Stroke and a Strange Intrapulmonary Shunt
- Centro Hospitalar Tondela-Viseu, Viseu, Portugal
Pulmonary arteriovenous malformations (PAVMs) spectrum extends from microscopic lesions to single or multiple large abnormal pulmonary artery to pulmonary venous connections. The main complications of PAVMs result from intrapulmonary shunt and include stroke, brain abscess, and hypoxemia. Paradoxical embolism is considered one of the main causes in young stroke patients and rarely, paradoxical embolism can also develop at pulmonary level. We describe a case of a previously healthy 44-year-old woman with the evidence of intrapulmonary shunt on transesophageal echocardiogram during the study of a cryptogenic stroke. However, no arteriovenous malformations were detected in spite of using advanced imaging techniques.
Keywords: Arteriovenous malformations, Cardiac imaging techniques, Paradoxical embolism, Stroke
Received: November 13, 2022; Revised: November 13, 2022; Accepted: December 19, 2022; Published: September 1, 2023 Show citation
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References
- Cartin-Ceba R, Swanson KL, Krowka MJ. Pulmonary arteriovenous malformations. Chest 2013;144:1033-1044.
Go to original source... 
Go to PubMed... - Shovlin CL. Pulmonary arteriovenous malformations. Am J Respir Crit Care Med 2014;190:1217-1228. Go to original source... Go to PubMed...
- Wozniak L, Mielczarek M, Sabiniewicz R. Paradoxical brain embolism in a young man: is it only a patent foramen ovale? Neurol Neurochir Pol 2015;49:61-64. Go to original source... Go to PubMed...
- Abushora MY, Bhatia N, Alnabki Z, et al. Intrapulmonary shunt is a potentially unrecognized cause of ischemic stroke and transient ischemic attack. J Am Soc Echocardiogr 2013;26:683-690. Go to original source... Go to PubMed...
- Felix A, Alcantara ML. To Close or not to Close PFOs in Cryptogenic Stroke, an Evolving Question. Int J Cardiovasc Sci 2020;33:318-320. Go to original source...
- Khabbaza JE, Krasuski RA, Tonelli AR. Intrapulmonary shunt confirmed by intracardiac echocardiography in the diagnosis of hepatopulmonary syndrome. Hepatology (Baltimore) 2013;58:1514-1515. Go to original source... Go to PubMed...
- Soliman OI, Geleijnse ML, Meijboom FJ, et al. The use of contrast echocardiography for the detection of cardiac shunts. Eur J Echocardiogr 2007;8:S2-S12. Go to original source... Go to PubMed...
- Kerut EK, Bourgeois B, Serio J, Nanda NC. Intrapulmonary shunts and its implications for assessment in stroke and divers with type II decompression illness. Echocardiography 2014;31:3-4. Go to original source... Go to PubMed...
- Nosib S, Watt K, Penz E, Fenton M. A 58-year-old woman with hypoxia, hypoxaemia, a hole in the heart and a … herring! Intracardiac or extracardiac shunt? That is the question! BMJ Case Rep 2015;2015:bcr2015211975. Go to original source... Go to PubMed...
- Erudilho E, Marchini JFM, Ghandour MS, et al. Percutaneous embolization of pulmonary arteriovenous fistulae in patients with hereditary hemorrhagic telangiectasia. Rev Bras Cardiol Invasiva 2013;21:85-88. Go to original source...
- White RI Jr. Pulmonary arteriovenous malformations: how do I embolize? Tech Vasc Interv Radiol 2007;10:283-290. Go to original source... Go to PubMed...
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