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Thorax 1999;54:1139-1140 doi:10.1136/thx.54.12.1139
  • Case Report

Paradoxical embolism in a boy with cystic fibrosis and a stroke

  1. S D Playfora,
  2. A R Smythb
  1. aDepartment of Paediatrics, Neonatal Intensive Care Unit, Queen's Medical Centre, Nottingham NG7 2UH, UK, bDepartment of Paediatric Respiratory Medicine, Nottingham City Hospital, Nottingham NG5 1PB, UK
  1. Dr S D Playfor
  • Received 15 December 1997
  • Accepted 2 March 1998

Abstract

An 11 year old boy with cystic fibrosis suffered a stroke, producing right sided weakness. Four years previously a totally implantable venous access device (Port-a-Cath) had been inserted. Magnetic resonance angiography revealed a filling defect in the left middle cerebral artery. Transoesophageal echocardiography demonstrated a thrombus attached to the tip of the Port-a-Cath and also the presence of a patent foramen ovale. After an initial period of anticoagulation the defect was closed using a septal occlusion device introduced via a cardiac catheter. The boy's neurological signs completely resolved and he remains free from further thromboembolic episodes. Whilst pulmonary embolism has been described before in relation to a totally implantable venous access device, this is believed to be the first description of a paradoxical embolism in relation to such a device.

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