Kirino Makiko, Ochiai Masayuki, Ichiyama Masako, Inoue Hirosuke, Kusuda Takeshi, Kinjo Tadamune, Ishimura Masataka, Ohga Shouichi
Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Pediatrics, Fukuoka Children's Hospital and Medical Center, Fukuoka, Japan.
AJP Rep. 2017 Jan;7(1):e13-e16. doi: 10.1055/s-0037-1598044.
Neonatal thromboembolism occurs with various predispositions and triggers. Early diagnosis of the thrombosis is challenging and essential for the therapeutic interventions. We herein report two newborns who presented with transient hemi-lower limb ischemia due to (1) arterial thrombosis or (2) a persistent sciatic artery (PSA). The patient with arterial thrombosis showed elevations of fibrin degradation product and D-dimer and received antithrombin and heparin intravenously. The patient with PSA was immediately assessed by a contrast-enhanced computed tomography because of a transient ischemic episode with no evidence of hypercoagulability. Newborns suspected of having arterial thrombosis may need urgent surgical intervention along with thrombolytic and anticoagulant therapy to prevent organ ischemia and amputation of extremities. Conversely, some PSA cases have reportedly been treated conservatively. This vascular anomaly was previously reported as a cause of lower limb ischemia only in a newborn. PSA is a critical differential diagnosis of neonatal arterial thrombosis that needs urgent therapeutic intervention.
新生儿血栓栓塞可由多种易患因素和触发因素引起。血栓形成的早期诊断具有挑战性，但对于治疗干预至关重要。我们在此报告两名新生儿，他们因（1）动脉血栓形成或（2）持续性坐骨动脉（PSA）而出现短暂性下肢半侧缺血。动脉血栓形成的患者纤维蛋白降解产物和D-二聚体升高，并接受了静脉注射抗凝血酶和肝素治疗。由于出现短暂性缺血发作且无高凝状态证据，PSA患者立即接受了增强计算机断层扫描评估。怀疑患有动脉血栓形成的新生儿可能需要紧急手术干预以及溶栓和抗凝治疗，以防止器官缺血和肢体截肢。相反，据报道一些PSA病例采用了保守治疗。这种血管异常以前仅在新生儿中被报道为下肢缺血的原因。PSA是新生儿动脉血栓形成的关键鉴别诊断，需要紧急治疗干预。
