Hu Zehang, Gao Yi, Fan Shumin
Department of Ultrasound, Shenzhen Children's Hospital of China Medical University, Shenzhen, China.
Front Pediatr. 2024 Mar 21;12:1353883. doi: 10.3389/fped.2024.1353883. eCollection 2024.
Crohn's disease (CD) is a chronic, non-specific inflammatory disease of the intestinal tract with an unknown etiology. It presents with clinical symptoms such as abdominal distension, abdominal pain, diarrhea, bloody stools containing mucus or pus, and other manifestations. CD has a prolonged and chronic course and can lead to various complications that significantly impact patients' quality of life. Patients with CD have hypercoagulable blood and are prone to thromboembolic diseases, which pose a serious threat to their lives. Several studies have indicated that inflammatory bowel disease is a risk factor for venous thromboembolism. The pathogenesis involves abnormalities in the coagulation-anticoagulation system, fibrinolytic system, platelets, vascular endothelial dysfunction, as well as the effects of therapeutic agents. In this case report, we present a rare case of a 15-year-old female patient with active CD complicated by the presence of a right atrial thrombus. Laboratory tests revealed abnormalities in both the coagulation-anticoagulation system and fibrinolysis system in the patient. The initial diagnosis, based on transthoracic echocardiography and contrast-enhanced echocardiography, confirmed the presence of a thrombus in the right atrium. Subsequent administration of anticoagulant and thrombolytic therapy resulted in gradual reduction in size until complete disappearance, as evidenced by dynamic monitoring. Ultrasound examination is considered as the preferred method for follow-up evaluation in patients with CD due to its ability not only to assess gastrointestinal complications but also to aid early identification of cardiovascular complications, thereby enabling timely intervention and treatment-which remains our primary focus of research and effort.
克罗恩病(CD)是一种病因不明的慢性非特异性肠道炎症性疾病。其临床表现为腹胀、腹痛、腹泻、黏液脓血便等。CD病程迁延、慢性,可导致多种并发症,严重影响患者生活质量。CD患者血液呈高凝状态,易发生血栓栓塞性疾病,对生命构成严重威胁。多项研究表明,炎症性肠病是静脉血栓栓塞的危险因素。其发病机制涉及凝血-抗凝系统、纤溶系统、血小板异常,血管内皮功能障碍以及治疗药物的影响。在本病例报告中,我们呈现了一例罕见的15岁女性活动性CD患者并发右心房血栓形成的病例。实验室检查显示该患者的凝血-抗凝系统和纤溶系统均存在异常。基于经胸超声心动图和超声心动图造影的初步诊断证实右心房存在血栓。随后给予抗凝和溶栓治疗,动态监测显示血栓大小逐渐缩小直至完全消失。超声检查因其不仅能够评估胃肠道并发症,还能辅助早期识别心血管并发症,从而实现及时干预和治疗,被认为是CD患者随访评估的首选方法,这仍然是我们研究和努力的主要重点。