Cardiology Department, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt.
Cardiol J. 2010;17(4):408-11.
A 25 year-old female with a history of Caesarian section ten weeks ago presented with symptoms suggestive of pulmonary embolism. Transthoracic echocardiography revealed a free-floating large thrombus traversing the right atrial cavity. Transesophageal echocardiography confirmed the presence of an unattached thrombus that originated from the most proximal part of the inferior vena cava. Multi-slice computed tomography of the chest and abdomen revealed the thrombus to start from the intra-hepatic part of the inferior vena cava and extend through the right atrium. It also demonstrated multiple thrombi in the pulmonary vasculature, the largest being in the right main pulmonary artery and its lower lobe branch. The patient was triaged for surgical embolectomy under cardio-pulmonary bypass. Follow-up trans-thoracic and transesophageal echocardiography confirmed adequate removal of the thrombus. By genetic examination, she proved to have factor V 'Leiden' gene and two thrombophilia genes, all of which were positive in the heterozygous state. She had also a high serum homocysteine.
一位 25 岁女性，10 周前行剖宫产术，现出现疑似肺栓塞的症状。经胸超声心动图显示，一个游离的大血栓穿过右心房腔。经食管超声心动图证实存在一个起源于下腔静脉最近端的游离血栓。胸部和腹部多层计算机断层扫描显示血栓始于下腔静脉肝内部分，并延伸至右心房。还显示肺血管中有多个血栓，最大的位于右主肺动脉及其下叶分支。该患者在心肺转流下接受了外科取栓术的分诊。经胸超声心动图和经食管超声心动图随访证实血栓已充分清除。通过基因检查，她证实携带因子 V Leiden 基因和两种血栓形成倾向基因，均为杂合子状态阳性。她的血清同型半胱氨酸也很高。
