Pappas Anthony J, Knight Stephen W, McLean Katherine Zanyk, Bork Susan, Kurz Michael C, Sawyer Kelly N
Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan.
Oakland University William Beaumont School of Medicine, Rochester, Michigan.
J Emerg Med. 2016 Sep;51(3):298-302. doi: 10.1016/j.jemermed.2016.05.026. Epub 2016 Jun 25.
Venous thromboembolism, including pulmonary embolism (PE), is a common disease identified in the emergency department that carries significant morbidity and mortality. In its most severe form, PE is fulminant and characterized by cardiac arrest and death.
In the midst of risk-stratifying PE by using echocardiography to assess right ventricular function, thrombus-in-transit (free-floating clot in the right atrium or ventricle) may be seen. We present a case of a 49-year-old man diagnosed with an acute saddle PE who was incidentally found to have a thrombus-in-transit and patent foramen ovale and required open thrombectomy. Identification of these additional potentially life-threatening features was possible only due to our availability of risk-stratification resources, specifically bedside echocardiography. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Albeit rare, with a reported incidence estimated at 4%, the presence of thrombus-in-transit may change emergent clinical management. A multidisciplinary team of resources should be considered emergently as part of a hospital-based PE system of care.
静脉血栓栓塞症，包括肺栓塞（PE），是急诊科常见的疾病，具有较高的发病率和死亡率。最严重的形式是暴发性肺栓塞，其特征是心脏骤停和死亡。
在通过超声心动图评估右心室功能对肺栓塞进行风险分层的过程中，可能会发现移行血栓（右心房或右心室内的游离漂浮血栓）。我们报告一例49岁男性，诊断为急性鞍状肺栓塞，偶然发现有移行血栓和卵圆孔未闭，需要进行开放性血栓切除术。仅由于我们具备风险分层资源，特别是床旁超声心动图，才得以识别这些额外的潜在危及生命的特征。
急诊医生为何应了解这一点？：尽管移行血栓罕见，报道的发病率估计为4%，但其存在可能会改变紧急临床管理。作为医院肺栓塞护理系统的一部分，应紧急考虑组建多学科资源团队。
