Budavari Adriane I, Glenn Tyler J, Will Kristen K, Askew John W, Fortuin F David
Division of Hospital Internal Medicine, Department of Medicine, Mayo Clinic, Phoenix, Arizona 85054, USA.
J Hosp Med. 2009 May;4(5):E5-9. doi: 10.1002/jhm.464.
We describe a 79-year-old male with recurrent high-grade liposarcoma who developed postoperative chest pain, dyspnea, and hypoxia suspicious for acute pulmonary embolism (PE). However, electrocardiogram (ECG) was suggestive of an acute ST-elevation myocardial infarction (MI). Heparin was initiated and emergent coronary angiography was performed, which demonstrated a "cutoff sign" in the distal left anterior descending artery (LAD) consistent with coronary embolism. A patent foramen ovale (PFO) and bilateral pulmonary emboli were subsequently identified. It was concluded that the patient had suffered an acute PE, with a portion of clot traversing the PFO and entering the LAD, resulting in a simultaneous acute ST-elevation MI. While the case described is rare, the underlying anatomical variant is common and may have practical significance. We discuss the literature regarding PFO with acute PE and paradoxical emboli.
我们描述了一名79岁的复发性高级别脂肪肉瘤男性患者，术后出现胸痛、呼吸困难和低氧血症，怀疑为急性肺栓塞（PE）。然而，心电图（ECG）提示急性ST段抬高型心肌梗死（MI）。开始使用肝素并进行了急诊冠状动脉造影，结果显示左前降支（LAD）远端有“截断征”，符合冠状动脉栓塞。随后发现了卵圆孔未闭（PFO）和双侧肺栓塞。得出的结论是，该患者发生了急性PE，一部分血栓穿过PFO进入LAD，导致同时发生急性ST段抬高型MI。虽然所描述的病例罕见，但潜在的解剖变异很常见，可能具有实际意义。我们讨论了有关PFO合并急性PE和反常栓塞的文献。
