Paradoxical embolism in a boy with cystic fibrosis and a stroke.
An 11 year old boy with cystic fibrosis suffered a stroke, producing right sided weakness. Four years previously a totally implantable venous access device (Port-a-Cath) had been inserted. Magnetic resonance angiography revealed a filling defect in the left middle cerebral artery. Transoesophageal echocardiography demonstrated a thrombus attached to the tip of the Port-a-Cath and also the presence of a patent foramen ovale. After an initial period of anticoagulation the defect was closed using a septal occlusion device introduced via a cardiac catheter. The boy's neurological signs completely resolved and he remains free from further thromboembolic episodes. Whilst pulmonary embolism has been described before in relation to a totally implantable venous access device, this is believed to be the first description of a paradoxical embolism in relation to such a device.
Playfor
S D
SD
Department of Paediatrics, Neonatal Intensive Care Unit, Queen's Medical Centre, Nottingham NG7 2UH, UK.
Smyth
A R
AR
D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002648:Child; D003550:Cystic Fibrosis / Q000150:complications*; D019320:Embolism, Paradoxical / Q000209:etiology*; D006801:Humans; D008297:Male; D020521:Stroke / Q000150:complications*