Suzuki J, Kanbayashi T, Koizumi T, Honda T, Yamada H, Sekiguchi M
First Department of Internal Medicine, Shinshu University School of Medicine, Nagano, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1992 Sep;30(9):1761-5.
A 37-year-old man was admitted with facial edema and right arm swelling. Venography, computed tomography and magnetic resonance imaging showed massive organizing thrombi in the superior vena cava and bilateral internal jugular as well as subclavian veins, and showed no mass lesions occluding the veins in the mediastinum. Angioscopy demonstrated a white thrombus at the entrance of the right subclavian vein. All results of blood coagulation tests were normal. The patient was diagnosed as having superior vena cava syndrome caused by idiopathic venous thrombosis. Anti-coagulant therapy with intravenous tissue plasminogen activator injection and continuous urokinase and heparin infusion into the thrombi through a catheter were not effective in lysing the thrombi. Collateral circulation gradually developed and his symptoms decreased. We decided to follow this patient on warfarin medication because of the difficulty in removing the thrombi surgically.
一名37岁男性因面部水肿和右臂肿胀入院。静脉造影、计算机断层扫描和磁共振成像显示上腔静脉、双侧颈内静脉及锁骨下静脉内有大量机化血栓，纵隔内未见阻塞静脉的占位性病变。血管镜检查显示右锁骨下静脉入口处有白色血栓。所有凝血检查结果均正常。该患者被诊断为特发性静脉血栓形成导致的上腔静脉综合征。静脉注射组织纤溶酶原激活剂以及通过导管向血栓内持续输注尿激酶和肝素进行抗凝治疗，均未能有效溶解血栓。侧支循环逐渐形成，他的症状有所减轻。由于手术清除血栓困难，我们决定让该患者接受华法林药物治疗并进行随访。
