TIA Caused by Contrast Echocardiography in Patient with Platypnea–Orthodeoxia

Abstract

Platypnea-orthodeoxia syndrome (POS) is a rare clinical disorder characterized by dyspnea caused by the upright position and relieved at recumbent position. Few cases of POS and stroke were reported in literature, and the association between stroke and POS with evidence of patent foramen ovale (PFO) is rare. Stroke may occur in patients with cardiac shunt who undergo contrast echocardiography. We present a patient with POS who experienced transitory ischemic attack (TIA) most likely caused by injection of agitated saline microbubbles during screen for PFO. No case report of TIA/stroke during contrast echocardiography in patients with POS has previously been published.

Cerebral arterial gas embolism proven by computed tomography following transthoracic echocardiography using bubble contrast

“…Although ischaemic neurological events have been reported post BCE, none of these cases demonstrated intravascular air on imaging. 2,3 It is well recognised that not all cases of CAGE show gas on brain imaging. 4,5 Although microbubbles entering the arterial circulation almost inevitably pass to the cerebral circulation during BCE, they rarely cause symptoms because of their small size.…”

Transient Ischemic Attack Caused by Contrast Echocardiography in a Patient with Platypnea‐Orthodeoxia

“…We read with interest the recent report by Loncar et al 1 The authors report a case of transient right hemiparesis temporally associated with the intravenous injection of agitated saline microbubbles. The study reportedly revealed "massive passage" of the agitated saline into the left heart in the setting of a large atrial septal aneurysm and two separate atrial septal defects.…”

Obscurum Per Obscurius. Which Contrast Agent Should Be Contraindicated for Cardiac Shunt Detection (Agitated Saline Agent vs. Ultrasound Contrast Agent)?

“…Obviously, we used the more general term contrast echocardiography instead of agitated saline contrast echocardiography in the title of our case report. 1 The title has been intended to be clear and as short as possible with necessity to include additional significant terms. Contrast echocardiography means use of whether agitated saline agent or ultrasound contrast agents (UCAs).…”