Paradoxical emboli after central venous catheter removal

Central venous catheters are widely used in intensive medicine to provide b lood product, nutritional and antibiotic support. A 45-year-old man with an unsuspected patent foramen ovale underwent a bone marrow allograft for poo r-risk acute lymphoblastic leukaemia. His venous line was removed because o f probable infection, and he simultaneously sustained a myocardial infarct and a cerebrovascular accident. He made a good recovery from both, but subs equently died of relapsed disease. Appropriate pre-transplant screening inv estigations are discussed, and the differential diagnosis of this complicat ion in the bone marrow transplant setting.