Portopulmonary venous anastomosis as a rare cause of embolic stroke following endoscopic cyanoacrylate injection for gastric variceal hemorrhage: A case report and review of the literature

Abstract

We report the case of a non‐cirrhotic 25‐year‐old female patient with cryptogenic portal hypertension who underwent cyanoacrylate injection for acute gastroesophageal variceal bleeding with a subsequent embolic stroke via a previously unrecognised portopulmonary venous anastomosis.

Paradoxical Cerebral Embolization during Transjugular Intrahepatic Portosystemic Shunt Creation and Variceal Sclerotherapy

“…33 Alternatively, PPVAs have been described in several case reports to be a source of paradoxical emboli that can result in neurologic events. 34,35 PPVAs occur when portal vein collaterals connect directly to pulmonary veins near the left atrium and form right-to-left shunts that can result in complications as well. Estimates of incidence vary but range from 1 to 30% in cirrhotic patients.…”

“…Estimates of incidence vary but range from 1 to 30% in cirrhotic patients. 34 One small series specifically screened for and examined the incidence of PPVAs during BRTO treatment in order to prevent non-target embolization. The authors found PPVAs in 21% of cases during retrograde angiography after balloon inflation and a subsequent right-to-left shunt in 31% of cases on echocardiography.…”