Ishihara Yukako, Hara Hidehiko, Saijo Tomokatsu, Namiki Atsushi, Suzuki Makoto, Hirai Hironori, Yamaguchi Tetsu
Third Department of Internal Medicine, Toho University School of Medicine, Ohashi Hospital, Tokyo, Japan.
Circ J. 2002 Jan;66(1):109-10. doi: 10.1253/circj.66.109.
A 66-year-old woman admitted with dyspnea on exertion had atrial fibrillation and left ventricular dysfunction. Echocardiography revealed an atrial septal defect (ASD) and a soft, easily deformable thrombus in the dilated left atrium. The atrial mass suddenly disappeared on the 10th day after admission, and contrast-enhanced chest computed tomography and pulmonary blood flow scintigraphy showed that the thrombus had detached from the left atrium, floated into the right atrium through the ASD and caused pulmonary embolism. This is the first documented case of a left atrial thrombus causing pulmonary embolism by passing through an ASD. When an ASD is present, it is important to consider not only paradoxical thromboembolism (from the right to the left atrium), but also pulmonary embolism caused by thromboembolism from the left to the right atrium.
一名66岁因劳力性呼吸困难入院的女性患者，患有心房颤动和左心室功能障碍。超声心动图显示存在房间隔缺损（ASD）以及扩张的左心房内有一个柔软、易于变形的血栓。入院第10天，心房内的肿块突然消失，对比增强胸部计算机断层扫描和肺血流闪烁显像显示血栓已从左心房脱落，通过ASD漂浮至右心房并导致肺栓塞。这是首例有记录的左心房血栓通过ASD导致肺栓塞的病例。当存在ASD时，不仅要考虑反常血栓栓塞（从右至左心房），还应考虑由左至右心房的血栓栓塞导致的肺栓塞。
