Korean J Nephrol.  2011 Nov;30(6):667-670.

A Case of Paradoxical Renal Embolism through Patent Foramen Ovale

• Lim DS
• Jeong ES
• Jung JS
• Chang SH
• Yoo SH
• Jang WJ
• Chung SJ

Abstract

Paradoxical embolism is a kind of stroke caused by embolism of thrombus of venous origin through a lateral opening in the heart, such as a patent foramen ovale (PFO). Although the most frequent manifestation of paradoxical embolism is cryptogenic stroke, noncerebral paradoxical embolism is also associated with PFO. We experienced a case of cryptogenic renal infarction in a previously healthy 70-year-old man. He had no cardiac thrombus on transthoracic echocardiography and electrocardiogram revealed a normal sinus rhythm. Because it was cryptogenic renal infarction, we performed transesophageal echocardiography with microbubble test. Microbubble test using agitated saline proved the presence of right-to-left shunt and patent foramen ovale was diagnosed. We also performed lower leg doppler ultrasonogram, but there was no evidence of deep vein thrombosis. Although only the presence of a right-to-left shunt is not enough to establish the diagnosis of paradoxical embolism, it is uncommon for the source of the embolism to be identified. In this case, we concluded that paradoxical embolism is the cause of renal embolism. We report paradoxical renal embolism through PFO with review of relevant literatures.

Keyword

Paradoxical embolism; Kidney; Infarction; Patent foramen ovale (PFO)

MeSH Terms

Aged
Dihydroergotamine
Echocardiography
Echocardiography, Transesophageal
Electrocardiography
Embolism
Embolism, Paradoxical
Foramen Ovale, Patent
Heart
Humans
Infarction
Kidney
Leg
Microbubbles
Stroke
Thrombosis
Venous Thrombosis
Dihydroergotamine