title: Embolization of a symptomatic systemic to pulmonary (right-to-left) venous shunt caused by fibrosing mediastinitis and superior vena caval occlusion.
abstract: Paradoxical embolization can occur when a right-to-left shunt allows a venous thromboembolus to escape filtration by the lungs. Venous collateral pathways draining into the left heart incited by superior vena cava obstruction are a rare acquired right-to-left shunt. Herein, the authors report on a case of transient ischemic attack in a patient with vena caval occlusion secondary to histoplasmosis-related fibrosing mediastinitis, with subclavian vein thrombosis and a right-to-left extracardiac shunt diagnosed with echocardiography. Despite the complexity of the collateral network, this shunt was successfully eradicated with coil embolization.
authors.affiliation: Division of Interventional Radiology, H-3646, Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5642, USA. dansze@stanford.edu <dansze@stanford.edu>
authors.forename: Daniel Y
authors.initials: DY
authors.lastname: Sze
authors.forename: Dominik
authors.initials: D
authors.lastname: Fleischmann
authors.forename: Adrian O
authors.initials: AO
authors.lastname: Ma
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Price
authors.forename: Michael V
authors.initials: MV
authors.lastname: McConnell
mesh_terms: D004621:Embolization, Therapeutic / Q000379:methods*; D006801:Humans; D008297:Male; D008480:Mediastinitis / Q000150:complications* / Q000628:therapy; D008875:Middle Aged; D011651:Pulmonary Artery / Q000002:abnormalities*; D011658:Pulmonary Fibrosis / Q000150:complications* / Q000628:therapy; D013479:Superior Vena Cava Syndrome / Q000150:complications* / Q000628:therapy*; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000002:abnormalities*