Sheikh Mujeeb, Emery Marie, Curtis Allison, King Stacie, Colyer William R
Department of Medicine, Division of Cardiovascular Medicine, University of Toledo Health Sciences Campus, Toledo, Ohio.
Echocardiography. 2014 Feb;31(2):E41-3. doi: 10.1111/echo.12408. Epub 2013 Dec 24.
Paradoxical embolism due to extracardiac right to left shunts (RLSs) manifesting as stroke remains anecdotal. We describe a case of 63-year-old female who presented with a transient ischemic attack and at agitated saline contrast echocardiogram was found to have an unusual type of an extracardiac RLS. Further evaluation leads to diagnosis of superior vena cava (SVC) thrombosis from a prior indwelling central venous catheter. The SVC thrombosis induced systemic-pulmonary venous collaterals were responsible for this unusual extracardiac RLS and paradoxical transient ischemic attack. We discuss the diagnosis and management of this rare clinical case.
心外右向左分流（RLS）导致的矛盾栓塞表现为中风的情况仍属罕见。我们描述了一例63岁女性，她因短暂性脑缺血发作就诊，经盐水激发对比超声心动图检查发现有一种不寻常的心外RLS类型。进一步评估发现是由于先前留置中心静脉导管导致上腔静脉（SVC）血栓形成。SVC血栓形成引起的体肺静脉侧支循环是这种不寻常的心外RLS和矛盾性短暂性脑缺血发作的原因。我们讨论了这一罕见临床病例的诊断和管理。
