Kobayashi Hideo, Mimura Satoshi, Kanoh Soichiro, Motoyoshi Kazuo
Third Department of Internal Medicine, National Defense Medical College, 3-2, Namiki, Tokorozawa, Saitama 359-8513.
Nihon Kokyuki Gakkai Zasshi. 2004 May;42(5):454-6.
We report a case of pulmonary thromboembolism, in which obstruction of the right subclavian vein, also called Paget-von Schroetter syndrome, was detected. The patient was a 39-year-old man (a scaffold constructor). He lost consciousness at work, and was admitted as an emergency case to our hospital. He had noticed gradually worsening dyspnea for 1 month. Chest radiography showed Westmark's sign in the lungs and enlarged hilar vascular markings on both sides. Pulmonary perfusion scintigraphy confirmed multiple flow defects. Upper and lower limb venography disclosed interruption of the right subclavian vein, leading to a diagnosis of pulmonary thromboembolism secondary to upper limb vein thrombosis. In patients who have pulmonary thromboembolism without an apparent underlying disease, the lifestyle and work habits should be considered and the possibility of subclavian vein thrombosis should be kept in mind.
我们报告一例肺血栓栓塞病例,其中检测到右锁骨下静脉阻塞,也称为佩吉特 - 冯·施罗特综合征。患者为一名39岁男性(脚手架搭建工人)。他在工作时失去意识,作为急诊病例被收治入院。他已逐渐加重的呼吸困难1个月。胸部X线片显示肺部有韦斯特马克征及双侧肺门血管影增粗。肺灌注闪烁扫描证实存在多处血流缺损。上肢和下肢静脉造影显示右锁骨下静脉中断,导致诊断为上肢静脉血栓形成继发的肺血栓栓塞。对于无明显基础疾病的肺血栓栓塞患者,应考虑其生活方式和工作习惯,并牢记锁骨下静脉血栓形成的可能性。