Ro Ayako, Kageyama Norimasa, Tanifuji Takanobu, Kobayashi Masahiko, Takada Aya, Saito Kazuyuki, Murai Tatsuya
Department of Legal Medicine, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
Leg Med (Tokyo). 2003 Mar;5 Suppl 1:S315-7. doi: 10.1016/s1344-6223(02)00159-1.
As the pathological features of acute massive pulmonary thromboembolism (PTE) remain unclear, early diagnosis is difficult. We examined 14 autopsy cases of sudden death by massive PTE. Eight cases were male and six female, with a mean age of 57+/-18 years. While none of the cases were diagnosed with PTE during their lifetime, 12 cases had predicting factors for thrombosis. Deep vein thrombosis was found at autopsy in 11 cases. Cross sections of each segmental pulmonary artery were dissected for histological examination. The distribution of fresh thrombi and organized thrombi in the pulmonary arteries was investigated. Results revealed that 13 cases contained both fresh and organized thrombi. More detailed examination indicated that as the organized thrombi were spread in all lobes, the distribution of thrombi extended from the proximal to peripheral arteries. Our findings indicated that most cases of fatal PTE had a subclinical recurrent history. Thus, proper diagnosis and treatment of prior emboli may be vital for the prophylaxis of sudden death by PTE.
由于急性大面积肺血栓栓塞症（PTE）的病理特征尚不清楚，早期诊断困难。我们检查了14例因大面积PTE猝死的尸检病例。其中8例为男性，6例为女性，平均年龄57±18岁。虽然所有病例生前均未被诊断为PTE，但12例有血栓形成的预测因素。尸检发现11例有深静脉血栓形成。对各段肺动脉横截面进行解剖以进行组织学检查。研究了肺动脉中新鲜血栓和机化血栓的分布。结果显示，13例同时含有新鲜血栓和机化血栓。更详细的检查表明，随着机化血栓在所有肺叶中扩散，血栓分布从近端动脉延伸至外周动脉。我们的研究结果表明，大多数致命性PTE病例有亚临床复发史。因此，对先前栓塞进行正确诊断和治疗可能对预防PTE猝死至关重要。
