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Impending paradoxical embolism: have we lost the clot?
Finn Ghent1, Levi Bassin, Michael Keller
1Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, Australia.
The Clinical Respiratory Journal
|December 17, 2013
Summary
A rare case of impending paradoxical embolism was treated with surgery. The blood clot unexpectedly reappeared in the superior vena cava cannula after appearing to embolize during surgery.
Area of Science:
- Cardiovascular Surgery
- Vascular Medicine
- Diagnostic Imaging
Background:
- Impending paradoxical embolism is a critical diagnosis necessitating prompt intervention.
- Surgical thromboembolectomy is a primary treatment modality for such cases.
Observation:
- A patient presented with suspected impending paradoxical embolism.
- Transesophageal ultrasound initially showed the thrombus disappearing, suggesting embolization during cardiopulmonary bypass.
- The surgical team prepared for potential complications arising from embolized thrombus.
Findings:
- The presumed embolized thrombus was unexpectedly discovered entangled within the apertures of the superior vena cava cannula.
- This finding challenges the initial assumption of complete embolization and highlights an unusual anatomical trapping mechanism.
Implications:
- This case underscores the importance of thorough intraoperative assessment and awareness of atypical thrombus migration patterns.
- It suggests that even when a thrombus appears to embolize, its location may be confined to unexpected sites, requiring vigilant surgical inspection.
- Further understanding of such paradoxical events can refine surgical strategies for thromboembolic disease.
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