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Paradoxical embolism: an underestimated entity. A plea for comprehensive work-up
A F AbuRahma1, F C Lucente, J P Boland
1Department of Surgery, West Virginia University Health Sciences Center, Charleston Area Medical Center.
The Journal of Cardiovascular Surgery
|November 1, 1990
Summary
A significant number of arterial embolism cases remain undiagnosed. In patients under 50, paradoxical embolism should be investigated using contrast echocardiography.
Area of Science:
- Cardiovascular Medicine
- Diagnostic Imaging
- Vascular Surgery
Background:
- Arterial embolism presents a diagnostic challenge, necessitating comprehensive work-up.
- Understanding the source of emboli is crucial for effective patient management and secondary prevention.
Observation:
- A review of 41 arterial embolism cases revealed varied diagnostic approaches, including echocardiography and arteriography.
- Cardiac and arterio-arterial sources were identified in a proportion of patients.
- A notable percentage of cases, particularly in younger patients (<50 years), had an unknown source or potential paradoxical embolism.
Findings:
- Cardiac sources (probable and possible) accounted for 49% of identified emboli.
- Paradoxical embolism was identified in 12% of cases, with a higher prevalence in patients under 50.
- In 22% of cases, the source of arterial embolism remained unknown after conventional work-up.
Implications:
- A significant proportion of patients with arterial embolism are discharged without a definitive source identified.
- Paradoxical embolism should be strongly considered in younger patients, with contrast echocardiography recommended for diagnosis.
- Improved diagnostic strategies are needed to elucidate the etiology of arterial embolism, especially in cases with initially unknown sources.