Embolization of a Symptomatic Systemic to Pulmonary (Right-to-left) Venous Shunt Caused by Fibrosing Mediastinitis and Superior Vena Caval Occlusion
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.
aDivision of Interventional Radiology, H-3646, Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5642
bDivision of Cardiovascular Imaging, H-3646, Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5642
cDivision of Cardiovascular Medicine, H-3646, Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5642
dDivision of Hematogy, H-3646, Stanford University Medical Center, 300 Pasteur Dr, Stanford, CA 94305-5642
Address correspondence to D.Y.S.
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.
ABSTRACT