"Paradoxical embolism" - a misnomer?

Abstract

Dear Editor, I wish to comment on two articles published in the December 2007 issue. Firstly I sympathise with the plight of the European doctors wishing to perform diving medicals that are accepted by the Queensland Government. As you will be aware SPUMS is not a regulatory body and had no input into the decision of the Queensland Government to use the SPUMS Diving Doctors List (DDL) as a reference list for doctors able to perform diving medicals. The DDL is a service offered to the SPUMS membership, and not all doctors who are members of SPUMS are included on the list. Rather it contains only those who have done the appropriate courses/training and then have applied annually to be listed. Doctors who are not members of SPUMS but are 'qualified' are also not on the DDL. To me the solution is easy for our European colleagues - become a SPUMS member and apply. As Dr J Wendling indicated the EDTC/ECHM standards are acceptable to SPUMS so the process would be simple. The application forms can be found on the SPUMS website: www.spums.org.au. Secondly the term;'paradoxical embolisation' was used in the book review by Dr Boon von Ochsèe. It was an excellent review and has prompted me to buy the book but I would like to question the use of the word 'paradoxical' when referring to air embolism associated with a patent foramen ovale. I know it is a term frequently used and, therefore, I am not arguing with Dr Boon. However, the word 'paradox' means "statement contrary to accepted opinion;…person or thing conflicting with preconceived notions of what is reasonable or possible". By this definition, surely there is nothing paradoxical about an air embolism associated with two connected chambers of the heart - any connection would mean a mixing of the chamber's contents? I believe the term should be reserved for embolisation in which no communication between the atria or any other right-to-left communication is found.