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Unusual presentation of more common disease/injury
CASE REPORT
Atrial septal aneurysm with rare comorbid pulmonary arteriovenous malformation as aetiology for cryptogenic stroke
  1. Kendall Bell1,
  2. Ahmad Abu-Heija1,
  3. Antonio Smith1 and
  4. Ijeoma Nnodim2
  1. 1 Internal Medicine, Wayne State University Physician Group, Detroit, Michigan, USA
  2. 2 Internal Medicine and Pediatrics, Wayne State University School of Medicine, Detroit, Michigan, USA
  1. Correspondence to Dr Kendall Bell, fa3345{at}wayne.edu

Abstract

Atrial septal aneurysms have two mechanisms for cardioembolic events. One is the aneurysm itself can act as a nidus for thrombus formation in the left atrium. The aneurysm creates an area of low turbulence leading to haemostasis allowing fibrin-platelet adhesions to form. If the clot is on the left atrial wall, it may be dislodged by oscillations of the septum and travel into the systemic circulation. The second mechanism is via, an often comorbid, interatrial shunt such as a Patent Foramen Ovale or Atrial Septal Defect. We report a unique case where the associated right to left shunt leading to the cryptogenic stroke is a pulmonary arteriovenous malformation.

  • cardiovascular medicine
  • neurology
  • stroke
  • medical management

https://doi.org/10.1136/bcr-2019-229282

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    Footnotes

    • Contributors KB and AA-H were involved directly with patient’s care as resident physicians. IN served as attending physician for the case. AS, KB and AA-H worked together with the literature review, writing the draft for the case and with the editing. IN helped with the editing of the case. All authors have read the final draft and have given their approval. KB made revisions suggested by the reviewers, and all authors have reviewed the revised copy and given their approval.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Next of kin consent obtained.