Diagnostic Yield of Venous Thrombosis and Pulmonary Embolism by Combined CT Venography and Pulmonary Angiography in Patients with Cryptogenic Stroke and Patent Foramen Ovale

2015 ◽  
Vol 74 (1-2) ◽  
pp. 69-72 ◽  
Author(s):  
Bertrand Lapergue ◽  
Jean Pierre Decroix ◽  
Serge Evrard ◽  
Adrien Wang ◽  
David Bendetowicz ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thrombosis ◽  
Patent Foramen Ovale ◽  
Diagnostic Yield ◽  
Cryptogenic Stroke ◽  
Pulmonary Angiography ◽  
Foramen Ovale ◽  
Ct Venography

Abstract W MP64: Evaluation of Deep Venous Thrombosis in Cryptogenic Stroke and Patent Foramen Ovale

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Ava L Liberman ◽  
Vistasp Daruwalla ◽  
Deborah Bergman ◽  
Richard A Bernstein ◽  
Yvonne Curran ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Foramen Ovale ◽  
Chi Square ◽  
Stroke Subtypes ◽  
Contrast Enhanced ◽  
Paradoxical Embolus ◽  
Stroke Mechanism

Background and Purpose: In cryptogenic stroke (CS), paradoxical embolus has been suggested as a stroke mechanism. A prior study found a significant rate of pelvic deep venous thrombosis (DVT) using magnetic resonance venography (MRV). We sought to evaluate the yield of diagnostic tests for lower extremity (LE) and pelvic DVT in stroke patients with patent foramen ovale (PFO) and in the subset with CS. Methods: A single center retrospective study was performed to identify consecutive ischemic stroke or TIA patients with PFO who underwent contrast-enhanced 3D pelvic MRV imaging (Ablavar, Lantheus Medical Imaging, N. Billerica, MA) between 2009 and 2013 as part of an inpatient diagnostic evaluation. Results of pelvic MRV, LE Doppler ultrasound (US) as well as clinical data were abstracted. Ischemic subtype was retrospectively assigned using the Causative Classification System (CCS). Patients with possible cardio-aortic embolism and undetermined cause by CCS were classified as CS. We estimated point estimates and 95% confidence intervals (CI) for DVT prevalence among stroke subtypes using the Wald method and compared these using Chi-square tests. Results: Of 130 patients who met study criteria, mean age was 56 +/- 17 years and median time from admission to MRV was 2 days (IQR 1-3). Overall DVT prevalence was 7.7% (95% CI, 4.1 to 13.7); the prevalence of pelvic DVT was 1.6% (95% CI, 0.07 to 5.8) and that of LE DVT was 7.2% (95% CI, 3.7 to 13.3). Of the patients with pelvic DVT (n=2), one patient also had a LE DVT by US. When MRV or US was obtained within 72 hours following admission, the prevalence of pelvic DVT was 2.1% (95% CI, 0.12 to 7.7) and that of LE DVT was 7.8% (95% CI, 3.8 to 14.8). Comparing patients with CS (n=97) to other subtypes (n=33), there was no difference in the prevalence of pelvic DVT (2.1% vs. 0%, P=1), LE DVT (6.3% vs. 10.3%, P=0.43) or any DVT (7.2% vs. 9.1%, P=0.71). Conclusion: Patients with CS and PFO have similar prevalence of DVTs compared to other stroke subtypes. The majority of detected DVTs were in LE veins rather than pelvic veins. Only a single patient with a pelvic DVT did not have a coexistent LE DVT. Our results suggest that the utility of pelvic MRV may be much lower than previously reported.

Combined CT Venography and CT Pulmonary Angiography for the Detection of Deep Venous Thrombosis in Injured Patients

2008 ◽  
Vol 74 (10) ◽  
pp. 935-938 ◽  
Author(s):  
Christian Jones ◽  
Pedro G.R. Teixeira ◽  
Kenji Inaba ◽  
Sravanthi R. Keesara ◽  
Peter Rhee ◽  
...  
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Diagnostic Yield ◽  
Pulmonary Angiography ◽  
Trauma Patients ◽  
Ct Pulmonary Angiography ◽  
Additional Time ◽  
Ct Venography ◽  
Venous Circulation ◽  
Level I

CT Venography (CTV) performed at the time of CT pulmonary angiography (CTPA) images the central, pelvic, and extremity venous circulation with minimal additional time, radiation, and no added contrast. CTV has been added to CTPA routinely at our Level I trauma center since 2000, and we sought to determine if this addition had increased the diagnostic yield of CTPA in trauma patients. The attending radiologist's interpretation of all CTPA-CTV studies performed over a 5-year period ending in August 2006 were retrospectively reviewed. CTPAs and CTVs were categorized as “positive”, “negative”, or “indeterminate” for pulmonary embolus (PE) and deep venous thrombosis (DVT). During the study period, 3798 patients underwent both a CTPA and CTV; 309 (8%) of these were trauma patients. Forty-four (14%) had a PE diagnosed on CTPA. Seventeen (6%) had a DVT diagnosed on CTV. In eight (3%), the CTV added clinically relevant data, diagnosing a DVT in a patient without PE. As the consequences of a missed pelvic DVT are high and the added time burden, radiation, and contrast required for a CTV are low, further investigation into optimizing the sensitivity of CTV performed at the time of CTPA is warranted.

scholarly journals Coincidence of deep venous thrombosis, pulmonary embolism and multiple paradoxical embolisms in a patient with patent foramen ovale

Cor et Vasa ◽  
2011 ◽  
Vol 53 (11) ◽  
pp. 654-657 ◽  
Author(s):  
Leona Pávková ◽  
Pavel Jelínek ◽  
Ladislav Pešl ◽  
František Toušek
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Patent Foramen Ovale ◽  
Foramen Ovale

Deep Venous Thrombosis with Suspected Pulmonary Embolism: Detection with Combined CT Venography and Pulmonary Angiography

Radiology ◽  
2001 ◽  
Vol 219 (2) ◽  
pp. 498-502 ◽  
Author(s):  
Peter A. Loud ◽  
Douglas S. Katz ◽  
Dennis A. Bruce ◽  
Donald L. Klippenstein ◽  
Zachary D. Grossman
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Pulmonary Angiography ◽  
Suspected Pulmonary Embolism ◽  
Ct Venography

Patent foramen ovale in patients with pulmonary embolism: A prognostic factor on CT pulmonary angiography?

2018 ◽  
Vol 12 (4) ◽  
pp. 271-274 ◽  
Author(s):  
Meng Zhang ◽  
Stephanie Tan ◽  
Vishal Patel ◽  
Benjamin A. Zalta ◽  
Anna Shmukler ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Prognostic Factor ◽  
Patent Foramen Ovale ◽  
Pulmonary Angiography ◽  
Foramen Ovale ◽  
Ct Pulmonary Angiography

scholarly journals High Frequency of Silent Pulmonary Embolism in Patients With Cryptogenic Stroke and Patent Foramen Ovale

Stroke ◽  
2011 ◽  
Vol 42 (3) ◽  
pp. 822-824 ◽  
Author(s):  
Christian Tanislav ◽  
Maximilian Puille ◽  
Wolfgang Pabst ◽  
Frank Reichenberger ◽  
Mathias Grebe ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Frequency ◽  
Patent Foramen Ovale ◽  
Cryptogenic Stroke ◽  
Foramen Ovale

scholarly journals Concomitant acute pulmonary embolism, myocardial infarction and ischemic stroke due to paradoxical embolism from a patent foramen ovale: a case report

2021 ◽  
Vol 2021 (10) ◽  
Author(s):  
Kiyoshi Takemoto ◽  
Michitaka Nakamura ◽  
Kazuaki Atagi
Keyword(s):  
Myocardial Infarction ◽  
Pulmonary Embolism ◽  
Ischemic Stroke ◽  
Medical History ◽  
Patent Foramen Ovale ◽  
Acute Pulmonary Embolism ◽  
Cryptogenic Stroke ◽  
Paradoxical Embolism ◽  
Whole Body ◽  
Foramen Ovale

ABSTRACT A patent foramen ovale (PFO) is a cause of paradoxical embolism. Although most patients with a PFO are asymptomatic, various clinical manifestations may be associated with PFO. The most important is a cryptogenic stroke. Concomitant acute pulmonary embolism (APE), acute myocardial infarction (AMI) and acute ischemic stroke (AIS) due to paradoxical embolism from a PFO are extremely rare. We describe a 77-year-old woman with a past medical history of hypertension who was transferred due to a sudden onset of dyspnea followed by cardiopulmonary arrest. Based on the patient’s medical history, transthoracic and transesophageal echocardiography, coronary angiography, and a whole-body contrasted computed tomography, we diagnosed concomitant APE, AMI and AIS caused by a paradoxical embolism from a PFO. Appropriate knowledge of the pathophysiology of this rare critical illness is important for prompt diagnosis and treatment.

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