Diamond Joshua M, Kotloff Robert M, Liu Christopher F, Cooper Joshua M
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.
Pacing Clin Electrophysiol. 2010 Apr;33(4):520-4. doi: 10.1111/j.1540-8159.2009.02652.x. Epub 2009 Dec 16.
A 73-year-old woman with a history of paroxysmal atrial fibrillation, sinus node dysfunction, bilateral breast cancer, and extensive chest radiation developed progressive edema, dyspnea, and recurrent pleural effusions soon after single-chamber pacemaker implantation. Thoracentesis yielded a diagnosis of chylothorax, and progressive refractory anasarca developed. A computed tomography angiogram suggested obstruction of the superior vena cava and left subclavian vein despite outpatient therapeutic anticoagulation. Autopsy confirmed venous thrombosis, along with mediastinal fibrosis. The presumed etiology of the chylothorax and anasarca was obstruction of the atretic central venous structures following pacemaker implantation, critically impairing the already tenuous venous and lymphatic drainage. (PACE 2010; 520-524).
一名73岁女性，有阵发性心房颤动、窦房结功能障碍、双侧乳腺癌病史且接受过广泛的胸部放疗，在植入单腔起搏器后不久出现进行性水肿、呼吸困难和反复胸腔积液。胸腔穿刺术诊断为乳糜胸，并出现进行性难治性全身性水肿。尽管门诊进行了治疗性抗凝，计算机断层血管造影显示上腔静脉和左锁骨下静脉阻塞。尸检证实存在静脉血栓形成以及纵隔纤维化。推测乳糜胸和全身性水肿的病因是起搏器植入后闭锁的中心静脉结构阻塞，严重损害了原本就脆弱的静脉和淋巴引流。（《PACE》2010年；520 - 524页）
