Delayed bubble, coil and trouble: young stroke as a presentation of paradoxical embolism from previously unrecognised pulmonary arterio-venous malformation (PAVM). Issue 3 (September 2020)

• Record Type: Journal Article
• Authors: Singh, Trisha; Hinton, Jonathan; Swallow, Rosie; Kersey, James; Hillier, Charles
• Is Part Of: Echo research and practice. Volume 7:Issue 3(2020)
• Page Start: K17
• Page End: K20
• Publication Date: 2020-09
• Subjects: patent foramen ovale -- pulmonary arteriovenous malformation -- contrast echocardiography; Echocardiography -- Periodicals; Heart -- Imaging -- Periodicals; 616.1207543
• DOI: 10.1530/ERP-20-0001
• Languages: English
• ISSNs: 2055-0456

Abstract

Abstract : Summary: Young stroke patients should be investigated thoroughly to look for cardiac and extra-cardiac sources of emboli. We present a patient who was investigated for a cardiac source of emboli following an ischemic stroke. She was found to have a small patent foramen ovale (PFO), but due to the late appearances of bubbles on the bubble study it was thought that this was an incidental finding. Further investigation confirmed a PAVM was the source of emboli causing her stroke. Learning points: Paradoxical embolus is a rare complication of a pulmonary arterio-venous malformation (PAVM). Young stroke patients should be investigated for intra and extra-cardiac shunts, in particular, patent foramen ovale (PFO), ideally with a bubble study. Consider an extra-cardiac source of embolism when bubbles are seen in arriving late into the left heart.