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A pneumothorax is a condition where air builds up in the space between the lung and the chest wall, causing the lung to collapse. This condition arises when air enters the space between the parietal and visceral pleura, disrupting the negative pressure essential for lung inflation. This can lead to a partial or complete collapse of the lung.
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[Paradoxical embolism: Myth or reality?]

P Aubry1, H Demian2, E Brochet3

  • 1Département de cardiologie, groupe hospitalier Bichat-Claude-Bernard, Assistance publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75018 Paris, France; Service de cardiologie, centre hospitalier de Gonesse, 95500 Gonesse, France.

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|November 4, 2017
PubMed
Summary
This summary is machine-generated.

Paradoxical embolism, often presenting as stroke, occurs with right-to-left shunts. Ruling out other cardiac sources and evaluating patent foramen ovale (PFO) are key for prevention strategies.

Keywords:
Accident vasculaire cérébralAtrial septal defectCommunication interauriculaireEmbolie paradoxaleEmbolie systémiqueForamen ovale perméableMalformations artérioveineuses pulmonairesParadoxical embolismPatent foramen ovalePulmonary arteriovenous malformationsRight-to-left shuntShunt droit–gaucheStrokeSystemic embolism

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Area of Science:

  • Cardiology
  • Neurology
  • Vascular Medicine

Background:

  • Paradoxical embolism involves a clot traveling from the venous to the arterial system.
  • Clinical presentation often mimics other thromboembolic events, necessitating differential diagnosis.
  • Right-to-left shunts, including patent foramen ovale (PFO) and atrial septal defects, are primary anatomical considerations.

Purpose of the Study:

  • To highlight the diagnostic considerations for paradoxical embolism.
  • To review the common clinical manifestations, particularly stroke.
  • To discuss current and emerging therapeutic strategies for secondary stroke prevention in patients with shunts.

Main Methods:

  • Review of clinical presentations and diagnostic criteria for paradoxical embolism.
  • Evaluation of anatomical right-to-left shunts, focusing on intracardiac defects and pulmonary arteriovenous malformations.
  • Assessment of scoring systems for determining stroke risk associated with PFO.
  • Analysis of therapeutic options including antithrombotic and percutaneous closure treatments.

Main Results:

  • Stroke is the most frequent clinical manifestation of paradoxical embolism.
  • Intracardiac defects (ASD, PFO) and pulmonary arteriovenous malformations are identified as sources of right-to-left shunting.
  • Risk stratification scores aid in evaluating the likelihood of PFO being stroke-related.
  • Recent randomized controlled trials are clarifying optimal secondary prevention strategies.

Conclusions:

  • Paradoxical embolism requires high clinical suspicion when thromboembolism occurs with a right-to-left shunt.
  • Thorough exclusion of other cardiac embolic sources is crucial.
  • Evidence from recent studies is refining the management of recurrent stroke prevention in patients with PFO.