Tsubono Masakazu, Shimizu Kazuhiro, Sato Shuji, Ito Takuro, Ikeda Takanori
Department of Internal Medicine, Toho University Omori Medical Center, Tokyo, Japan.
Department of Internal Medicine, Toho University Sakura Medical Center, Chiba, Japan.
Int Med Case Rep J. 2021 Feb 17;14:101-106. doi: 10.2147/IMCRJ.S280131. eCollection 2021.
Venous thromboembolism (VTE) may present acutely as pulmonary embolism (PE), and its late complications include chronic thromboembolic pulmonary hypertension (CTEPH). PEs may arise from thrombi originating in a venous aneurysm, in rare cases of the popliteal vein.
A 77-year-old woman was referred to our hospital due to respiratory distress. Computed tomography revealed pulmonary thrombi and a thrombus in a popliteal vein aneurysm (PVA); PE was diagnosed. After 3 months of anticoagulant therapy (rivaroxaban), her pulmonary hypertension showed little improvement. She underwent perfusion scintigraphy, which showed multiple perfusion defects, and Swan-Ganz catheterization. Mean pulmonary artery pressure was 26 mmHg. Pulmonary angiography revealed organized distal thrombi. Based on these findings, we diagnosed CTEPH due to recurrent formation of thrombi in the PVA.
Asymptomatic PVA can lead silently to PE and CTEPH. The possibility of asymptomatic recurrent VTE should be considered in patients with pulmonary hypertension and PVA.
静脉血栓栓塞症（VTE）可能急性表现为肺栓塞（PE），其晚期并发症包括慢性血栓栓塞性肺动脉高压（CTEPH）。在罕见的腘静脉病例中，肺栓塞可能源于静脉瘤内形成的血栓。
一名77岁女性因呼吸窘迫被转诊至我院。计算机断层扫描显示肺部血栓及腘静脉瘤（PVA）内的血栓；诊断为肺栓塞。经过3个月的抗凝治疗（利伐沙班），其肺动脉高压几乎没有改善。她接受了灌注闪烁扫描，显示多处灌注缺损，并进行了 Swan - Ganz 导管插入术。平均肺动脉压为26 mmHg。肺血管造影显示远端血栓已机化。基于这些发现，我们诊断为由于PVA内血栓反复形成导致的CTEPH。
无症状的PVA可悄然导致肺栓塞和CTEPH。对于患有肺动脉高压和PVA的患者，应考虑无症状复发性VTE的可能性。
