Medical image of the week: paradoxical stroke

• Main Authors: Zaid LA, Enakpene E, Natt B
• Format: Article
• Language: English
• Published: Arizona Thoracic Society 2014-11-01
• Series: Southwest Journal of Pulmonary and Critical Care
• Subjects: paradoxical stroke; arterial embolus; endocarditis; echocardiogram; ultrasound; magnetic resonance imaging; MRI; patent foramen ovale; right to left shunt; tricuspid valve
• Online Access: http://www.swjpcc.com/imaging/2014/11/5/medical-image-of-the-week-paradoxical-stroke.html

No abstract available. Article truncated after 150 words. A 23-year-old man with a history of intravenous drug abuse (IVDA) was admitted to the intensive care unit (ICU) secondary to sepsis. His blood cultures were positive for methicillin sensitive Staphylococcus aureus. Transthoracic echocardiogram showed vegetation on the tricuspid valve (Figure 1). He had multiple systemic emboli leading to suspicion for right to left shunt, which was confirmed by the agitated saline test during the echocardiogram (Figure 2). Cerebellar strokes likely secondary to posterior circulation embolic phenomenon was also seen (Figure 3). Overall, after a protracted ICU course complicated by multi-organ failure, he improved and is continuing treatment and rehabilitation at this time. Right-sided infective endocarditis (IE) incidence is low, accounting for 5-10% of all cases of IE (1). IVDA is a well-known cause of tricuspid valve endocarditis. Usual features of tricuspid endocarditis are fever, bacteremia and pulmonary septic emboli. Patent foramen ovale (PFO) is estimated in up to 25% ...