Journal of Vascular and Interventional Radiology
Volume 21, Issue 1 , Pages 140-143, January 2010

Embolization of a Symptomatic Systemic to Pulmonary (Right-to-left) Venous Shunt Caused by Fibrosing Mediastinitis and Superior Vena Caval Occlusion

  • Daniel Y. Sze, MD, PhD

      Affiliations

    • Division of Interventional Radiology, H-3646, Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5642
    • Corresponding Author InformationAddress correspondence to D.Y.S.
    • ,
  • Dominik Fleischmann, MD

      Affiliations

    • Division of Cardiovascular Imaging, H-3646, Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5642
    • ,
  • Adrian O. Ma, MD

      Affiliations

    • Division of Cardiovascular Medicine, H-3646, Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5642
    • ,
  • Elizabeth A. Price, MD

      Affiliations

    • Division of Hematogy, H-3646, Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5642
    • ,
  • Michael V. McConnell, MD, MSEE

      Affiliations

    • Division of Cardiovascular Medicine, H-3646, Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5642

Received 16 April 2009; received in revised form 12 September 2009; accepted 27 September 2009.

Paradoxical embolization can occur when a right-to-left shunt allows a venous thromboembolus to escape filtration by the lungs. Venous collateral pathways draining into the left heart incited by superior vena cava obstruction are a rare acquired right-to-left shunt. Herein, the authors report on a case of transient ischemic attack in a patient with vena caval occlusion secondary to histoplasmosis-related fibrosing mediastinitis, with subclavian vein thrombosis and a right-to-left extracardiac shunt diagnosed with echocardiography. Despite the complexity of the collateral network, this shunt was successfully eradicated with coil embolization.

Abbreviations: PFO, patent foramen ovale, SVC, superior vena cava, TTE, transthoracic echocardiography, TEE, transesophageal echocardiography

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 D.Y.S. is a consultant for MediGene, Inc., Jennerex Biotherapeutics, Inc., and Pain Therapeutics, Inc., and is a shareholder of NDC, Inc., none of which are pertinent to this manuscript. None of the other authors have identified a conflict of interest.

PII: S1051-0443(09)00964-6

doi:10.1016/j.jvir.2009.09.022

Journal of Vascular and Interventional Radiology
Volume 21, Issue 1 , Pages 140-143, January 2010

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