Central venous catheter thrombosis complicated by paradoxical embolism in a patient with diabetic ketoacidosis and respiratory failure.

Introduction: Paradoxical embolus should be suspected in young patients with cerebrovascular events who do not have any vascular risk factors. There is significant controversy as to how best to treat his phenomenon.
Methods: A case observation in a tertiary care center.
Results: A 46-year-old was admitted to the intensive care unit (ICU) for unresponsiveness secondary to diabetic ketoacidosis and acute respiratory distress syndrome. He was intubated, and central access was obtained through the right internal jugular vein. Initial computed tomography (CT) scan of his brain was unremarkable. Four days later, he suddenly became increasingly unresponsive. Repeat CT scan of the brain revealed large bilateral posterior infarcts. Transesophegeal echocardiogram revealed a patent foramen ovale (PFO), and Doppler ultrasound revealed a thrombus in the low right jugular vein. He was anticoagulated for 3 months with no intervention for his PFO.
Conclusion: This case emphasizes the potential complications of the use of central lines in ICUs, particularly in patients with diabetic ketoacidosis in whom sluggish blood flow may predispose to a procoagulant state.