Abstract
We experienced a case of cryptogenic renal infarction in a previously healthy 60-year-old man. He had no systemic atherosclerotic changes. Holter monitoring revealed no atrial fibrillation. Transthoracic echocardiography showed no thrombus. Because the onset occurred while he was swinging a golf club (a similar maneuver to holding the breath), further examination was performed with a view to detecting paradoxical embolism through the foramen ovale. A positive bubble test with the Valsalva maneuver during transesophageal echocardiography led to the diagnosis of patent foramen ovale (PFO). This was a suspected case of paradoxical embolism through a PFO leading to renal infarction.
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References
Domanovits H, Paulis M, Nikfardjam M, Meron G, Kürkciyan I, Bankier A, Laggner A. Acute renal infarction. Clinical characteristics of 17 patients. Medicine (Baltimore). 1999;78:386–94.
Lechat P, Mas J, Lascault G, Loron P, Theard M, Klimczac M, Drobinski G, Thomas D, Grosgogeat Y. Prevalence of patent foramen ovale in patients with stroke. N Engl J Med. 1988;318:1148–52.
Lamy C, Giannesini C, Zuber M, Arquizan C, Meder J, Trystram D, et al. Clinical and imaging findings in cryptogenic stroke patients with and without patent foramen ovale: the PFO-ASA Study. Atrial Septal Aneurysm. Stroke. 2002;33:706–11.
Lethen H, Flachskampf F, Schneider R, Sliwka U, Köhn G, Noth J, et al. Frequency of deep vein thrombosis in patients with patent foramen ovale and ischemic stroke or transient ischemic attack. Am J Cardiol. 1997;80:1066–9.
Yasaka M, Otsubo R, Oe H, Minematsu K. Is stroke a paradoxical embolism in patients with patent foramen ovale? Intern Med. 2005;44:434–8.
Hazanov N, Somin M, Attali M, Beilinson N, Thaler M, Mouallem M, et al. Acute renal embolism. Forty-four cases of renal infarction in patients with atrial fibrillation. Medicine (Baltimore). 2004;83:292–9.
Hagen P, Scholz D, Edwards W. Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clin Proc. 1984;59:17–20.
Ueno Y, Iguchi Y, Inoue T, Shibazaki K, Urabe T, Kimura K. Paradoxical brain embolism may not be uncommon-prospective study in acute ischemic stroke. J Neurol. 2007;254:763–6.
Bogousslavsky J, Garazi S, Jeanrenaud X, Aebischer N, Van MG. Stroke recurrence in patients with patent foramen ovale: the Lausanne Study. Lausanne Stroke with Paradoxal Embolism Study Group. Neurology. 1996;46:1301–5.
Cramer S, Rordorf G, Maki J, Kramer L, Grotta J, Burgin W, et al. Increased pelvic vein thrombi in cryptogenic stroke: results of the Paradoxical Emboli from Large Veins in Ischemic Stroke (PELVIS) study. Stroke. 2004;35:46–50.
Hara H, Virmani R, Ladich E, Mackey-Bojack S, Titus J, Reisman M, et al. Patent foramen ovale: current pathology, pathophysiology, and clinical status. J Am Coll Cardiol. 2005;46:1768–76.
Mohr JP, Thompson JL, Lazar RM, Levin B, Sacco RL, Furie KL, et al. A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke. N Engl J Med. 2001;345:1444–51.
Homma S, Sacco RL, Di Tullio MR, Sciacca RR, Mohr JP, PFO in Cryptogenic Stroke Study (PICSS) Investigators. Effect of medical treatment in stroke patients with patent foramen ovale: patent foramen ovale in Cryptogenic Stroke Study. Circulation. 2002;105(22):2625–31.
Prandoni P, Lensing AW, Cogo A, Cuppini S, Villalta S, Carta M, et al. The long-term clinical course of acute deep venous thrombosis. Ann Intern Med. 1996;125:1–7.
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Iwasaki, M., Joki, N., Tanaka, Y. et al. A suspected case of paradoxical renal embolism through the patent foramen ovale. Clin Exp Nephrol 15, 147–150 (2011). https://doi.org/10.1007/s10157-010-0354-4
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DOI: https://doi.org/10.1007/s10157-010-0354-4