Tukaye Deepali Nivas, Cavallazzi Rodrigo Silva
Division of Cardiology, The Ohio State University, Columbus, OH 43210, USA.
Division of Medicine Pulmonary Critical Care, University of Louisville, Louisville, KY 40202, USA.
Cardiol Res. 2014 Aug;5(3-4):112-117. doi: 10.14740/cr335w. Epub 2014 Jul 20.
The objective of this case study is to discuss a rare case of proven paradoxical thromboembolism captured in-transit. A 23-year-old female with a diagnosis of right internal jugular deep vein thrombus who developed acute onset chest pain, dyspnea and hypotension, was selected for the study. Sub-massive PE and STEMI were diagnosed. Transthoracic echocardiogram revealed a left ventricular (LV) mass moving across the aortic valve. Soon after, the patient developed numbness of right extremities with non-palpable pulses. A transesophageal echocardiogram revealed absent LV mass, PFO, left atrial mass entering through the PFO and emboli in bilateral pulmonary arteries. We report a case of sub-massive PE and paradoxical proven coronary and upper extremity embolism, captured in-transit, following destabilization of an UEDVT in a patient with PFO.
本病例研究的目的是讨论一例罕见的在转运过程中确诊的矛盾性血栓栓塞病例。一名23岁女性，诊断为右颈内静脉深静脉血栓形成，出现急性胸痛、呼吸困难和低血压，被选入本研究。诊断为次大面积肺栓塞和ST段抬高型心肌梗死。经胸超声心动图显示左心室（LV）团块穿过主动脉瓣。此后不久，患者出现右上肢麻木且脉搏触不到。经食管超声心动图显示左心室团块消失、卵圆孔未闭（PFO）、左心房团块通过卵圆孔进入以及双侧肺动脉内有栓子。我们报告一例次大面积肺栓塞以及经证实的矛盾性冠状动脉和上肢栓塞病例，该病例是在一名患有卵圆孔未闭的患者上肢深静脉血栓不稳定后在转运过程中确诊的。
