title: Inverse paradoxical embolism in a patient on chronic hemodialysis with aortic bacterial endocarditis.
abstract: 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.
authors.affiliation: Hospital Universitario "Virgen del Rocío", Sevilla, Spain. jrochac@medynet.com
authors.forename: J L
authors.initials: JL
authors.lastname: Rocha
authors.forename: F
authors.initials: F
authors.lastname: González-Roncero
authors.forename: R
authors.initials: R
authors.lastname: López-Hidalgo
authors.forename: L
authors.initials: L
authors.lastname: Gómez-García
authors.forename: C
authors.initials: C
authors.lastname: Martín-Herrera
authors.forename: M J
authors.initials: MJ
authors.lastname: Rodríguez-Puras
authors.forename: M
authors.initials: M
authors.lastname: Navarro
authors.forename: J J
authors.initials: JJ
authors.lastname: Castilla
mesh_terms: 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*