Transcranial Doppler of a paradoxical brain embolism associated with a pulmonary arteriovenous fistula

We herein report the case of a patient who had paradoxical brain embolism o wing to a pulmonary arterio-venous fistula (PAVF) who was diagnosed as havi ng a right-to left shunt by transcranial Doppler (TCD) with saline contrast medium. TCD with saline contrast medium failed to detect any high-intensit y transient signals immediately after catheter embolization of the PAVF. Th us, TCD with saline contrast medium was useful for identifying the presence of a right-to-left shunt and for confirming that the shunt had been oblite rated after endovascular treatment.