Inverse paradoxical embolism in a patient on chronic hemodialysis with aortic bacterial endocarditis.
We present a 45-year-old patient on chronic hemodialysis who suffered aortic endocarditis by Staphylococcus haemolyticus after bacteremia associated with a venous catheter, which was used temporarily during the maturing phase of a Cimino-Brescia arteriovenous fistula in the left forearm. Three weeks after starting antibiotic therapy, the patient suffered a septic pulmonary embolism. The catheter had been removed 4 weeks before the embolism. Thrombophlebitis of lower limbs, infection or thrombosis of the vascular access, and the involvement of right-sided cardiac structures were all discarded. We assumed that the pulmonary episode was probably a consequence of the paradoxical passage of embolic material, detached from the aortic valve, from arterial to venous circulation through the arteriovenous fistula.
Rocha
J L
JL
Hospital Universitario "Virgen del Rocío", Sevilla, Spain. jrochac@medynet.com
González-Roncero
F
F
López-Hidalgo
R
R
Gómez-García
L
L
Martín-Herrera
C
C
Rodríguez-Puras
M J
MJ
Navarro
M
M
Castilla
J J
JJ
D001021:Aortic Valve; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D016470:Bacteremia / Q000209:etiology; D002408:Catheters, Indwelling / Q000009:adverse effects; D019320:Embolism, Paradoxical / Q000209:etiology*; D004697:Endocarditis, Bacterial / Q000209:etiology*; D006349:Heart Valve Diseases / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000209:etiology*; D006435:Renal Dialysis; D013203:Staphylococcal Infections / Q000209:etiology*