Takeuchi Hidekazu
Ogachi Chuo Byoin, Akita, Japan.
BMJ Case Rep. 2017 Jan 6;2017:bcr2016218036. doi: 10.1136/bcr-2016-218036.
Stroke is a clinically important problem. A left atrial thrombus is known as a cause of ischaemic stroke. A pulmonary vein thrombus (PVT) is thought to be rare; however, PVT is common in elderly patients. Additionally, images of PVT with transoesophageal echocardiography (TEE) following treatment have not been well contrasted with that from either 64 or 80-slice multidetector CT (80-MDCT). The images of such changes depicted by TEE remain unknown. An 87-year-old man with hypertension was examined by 80-MDCT and TEE to check the cardiac thrombus. Although 80-MDCT did not depict the thrombus, TEE depicted the thrombus in the left atrium and right lower pulmonary vein (RLPV) clearly. After 6 months of rivaroxaban treatment, the thrombus in the RLPV decreased slightly and the thrombus in the left atrium became small and lucent, as estimated with TEE. Rivaroxaban decreased the size of the thrombus and changed the quality of the thrombus.
中风是一个具有临床重要性的问题。左心房血栓是缺血性中风的一个已知病因。肺静脉血栓（PVT）被认为较为罕见；然而，PVT在老年患者中很常见。此外，经食管超声心动图（TEE）检查治疗后PVT的图像与64排或80排多层螺旋CT（80-MDCT）的图像对比情况不佳。TEE所描绘的此类变化的图像仍不为人所知。一名患有高血压的87岁男性接受了80-MDCT和TEE检查以排查心脏血栓。尽管80-MDCT未显示血栓，但TEE清晰地显示了左心房和右下肺静脉（RLPV）中的血栓。利伐沙班治疗6个月后，经TEE评估，RLPV中的血栓略有减少，左心房中的血栓变小且变得透亮。利伐沙班减小了血栓的大小并改变了血栓的性质。
