Hattori Masashi, Sato Daiki, Yokoyama Takahito, Tsuda Yasutoshi, Nakajima Masato
Department of Cardiovascular Surgery, Yamanashi Prefectural Central Hospital, Kofu, Japan.
Kyobu Geka. 2021 May;74(5):383-387.
A mobile thrombus in the ascending aorta is extremely rare. A 57-year-old man was referred to our hospital with suspected esophageal cancer. Following thorough evaluation, he was diagnosed with esophageal cancer( UtMt type0-Ⅱa T1b, Mt type0-Ⅱc T1a N0M0 cStageⅠ) and tongue cancer in situ. He was administered preoperative chemotherapy comprising fluorouracil and cisplatin. The patient developed fever on day four of the first course of the chemotherapy. Contrast-enhanced chest and abdominal computed tomography revealed a mobile thrombus in the ascending aorta with bilateral partial renal infarction. We initiated intravenous unfractionated heparin and oral warfarin as anticoagulant therapy. The thrombus did not disappear despite ten-day treatment;therefore, he underwent aortic thrombectomy under hypothermic circulatory arrest with retrograde cerebral perfusion. Intraoperatively, we detected a pedunculated mobile thrombus attached to the aorta. His postoperative course was uneventful and he was treated at discharge with warfarin. He underwent video-assisted thoracoscopic esophagectomy postoperatively and was discharged without any complication. Currently, he showed no recurrent thrombus or cancer.
升主动脉内的移动血栓极为罕见。一名57岁男性因疑似食管癌被转诊至我院。经过全面评估，他被诊断为食管癌（UtMt型0-Ⅱa T1b，Mt型0-Ⅱc T1a N0M0 c期Ⅰ）和原位舌癌。他接受了包含氟尿嘧啶和顺铂的术前化疗。患者在化疗第一疗程的第四天出现发热。胸部和腹部增强计算机断层扫描显示升主动脉内有一个移动血栓，伴有双侧部分肾梗死。我们开始使用静脉普通肝素和口服华法林进行抗凝治疗。尽管治疗了十天，血栓仍未消失；因此，他在低温循环停搏并逆行脑灌注下接受了主动脉血栓切除术。术中，我们检测到一个附着在主动脉上的带蒂移动血栓。他的术后过程顺利，出院时接受华法林治疗。术后他接受了电视辅助胸腔镜食管癌切除术，出院时无任何并发症。目前，他没有出现血栓或癌症复发。
