Playing games with a thrombus: a dangerous match. Paradoxical embolism from a huge central venous cathether thrombus: a case report.
Thromboembolism is a major cause of death in cancer patients. The association between paraneoplastic hypercoagulability of oncological patients and long-term central venous catheters (CVC) may result in CVC associated thrombosis. Patent Foramen Ovale (PFO), especially when associated with atrial septal aneurysm (ASA) is a risk factor for paradoxical embolism. We report a case of paradoxical embolism with stroke in an oncological patient with a huge CVC thrombus playing "ping-pong" with an hypermobile ASA with a PFO. We review the management of hypercoagulability in oncologic patients and discuss the potential role of routine transthoracic echocardiography before the implantation of long term central venous catheters to identify predisposing conditions to paradoxical embolism and select patients for anticoagulant therapy.
Cardim
Nuno
N
Cardiology Department, Hospital da Luz, 1500-650 Lisbon, Portugal. ncardim@hospitaldaluz.pt
Toste
Júlia
J
Carvalho
Vanessa
V
Nunes
Igor
I
Ferreira
Daniel
D
Carmelo
Vanda
V
Oliveira
Ana S N
AS
Ferro
José
J
Mariana
Sylvie
S
Almeida
Adelaide
A
Machado
Francisco P
FP
Roquette
José
J
D000230:Adenocarcinoma / Q000150:complications / Q000188:drug therapy; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001778:Blood Coagulation Disorders / Q000209:etiology; D003110:Colonic Neoplasms / Q000150:complications / Q000188:drug therapy; D017548:Echocardiography, Transesophageal; D019320:Embolism, Paradoxical / Q000000981:diagnostic imaging* / Q000209:etiology*; D017809:Fatal Outcome; D005260:Female; D006325:Heart Atria; D006801:Humans; D008875:Middle Aged; D056824:Upper Extremity Deep Vein Thrombosis / Q000150:complications* / Q000000981:diagnostic imaging*; D014683:Vena Cava, Superior
D000970:Antineoplastic Agents