Takeuchi Hidekazu
Internal Medicine (Cardiology), Takeuchi Naika Clinic, Ogachi-Gun, JPN.
Cureus. 2024 Feb 25;16(2):e54881. doi: 10.7759/cureus.54881. eCollection 2024 Feb.
We have reported several cases of pulmonary vein thrombosis in elderly individuals with or without chest pain; pulmonary vein thrombosis is common in aged individuals and should be evaluated further. However, the properties and roles of pulmonary vein thrombi (PVTs) have not been determined. During infection, neutrophil extracellular traps (NETs) are produced to kill pathogens, and arterial thrombi (ATs) are produced in pulmonary veins to prevent pathogens from spreading to all organs. We reported that fine PVTs became larger PVTs and extended to the LA wall. PVTs can cause acute myocardial infarction (AMI) and ischemic stroke (IS) by releasing larger particles; therefore, the characteristics of PVTs need to be determined to prevent the occurrence of AMI and IS. PVTs can cause several diseases by releasing smaller particles, such as NETs, for which cumulative effects should be determined. PVTs and their effects on human health need to be studied to avoid missing the chances of treating patients with these diseases moderately. We reported that PVTs often extend to the left atrium (LA) and attach to the LA wall; however, the effects of attachment remain unclear. According to cardiac computed tomography (CT), left atrial diverticula (LADs) reportedly occur in 10%-50% of patients; however, the details of the LAD are unknown. Therefore, we examined the relationships among PVTs, LA thrombi, and LADs using cardiac CT and transesophageal echocardiography (TEE). The patient was a 65-year-old male with hypertension and severe palpitations. He had no history of AMI or IS. TEE revealed that the LA thrombi were attached to the anterior wall of the right lower pulmonary vein and that they were attached to the anterior wall of the LA. TEE revealed an LAD near the attachment area. Cardiac CT revealed an LAD without thrombi near the attachment area. Sagittal images from a cardiac CT scan revealed that a part of the attachment region in the LA was a dark line, where no blood flow was observed in the LA, and that there seemed to be the LAD on top of the dark line. The anomalistic branch of the right coronary artery (#1) connected around the top of the LAD.
我们已经报告了几例有或无胸痛的老年个体发生肺静脉血栓形成的病例；肺静脉血栓形成在老年人中很常见，应进一步评估。然而，肺静脉血栓（PVTs）的性质和作用尚未确定。在感染期间，会产生中性粒细胞胞外陷阱（NETs）来杀死病原体，并且在肺静脉中会形成动脉血栓（ATs）以防止病原体扩散到所有器官。我们报告过细小的PVTs会变成更大的PVTs并延伸至左心房壁。PVTs可通过释放较大颗粒导致急性心肌梗死（AMI）和缺血性中风（IS）；因此，需要确定PVTs的特征以预防AMI和IS的发生。PVTs可通过释放较小颗粒（如NETs）引发多种疾病，对此应确定其累积效应。需要研究PVTs及其对人类健康的影响，以免错过适度治疗这些疾病患者的机会。我们报告过PVTs常延伸至左心房（LA）并附着于LA壁；然而，附着的影响仍不清楚。据心脏计算机断层扫描（CT）报道，左心房憩室（LADs）在10% - 50%的患者中出现；然而，LAD的详细情况尚不清楚。因此，我们使用心脏CT和经食管超声心动图（TEE）检查了PVTs、LA血栓和LADs之间的关系。该患者是一名65岁男性，患有高血压和严重心悸。他没有AMI或IS病史。TEE显示LA血栓附着于右下肺静脉前壁且附着于LA前壁。TEE显示在附着区域附近有一个LAD。心脏CT显示在附着区域附近有一个无血栓的LAD。心脏CT扫描的矢状图像显示，LA中附着区域的一部分是一条暗线，在LA中未观察到血流，并且在暗线顶部似乎有LAD。右冠状动脉的异常分支（#1）连接在LAD顶部周围。
