Takeuchi Hidekazu
Internal Medicine (Cardiology), Takeuchi Naika Clinic, Ogachi-Gun, JPN.
Cureus. 2025 Feb 1;17(2):e78334. doi: 10.7759/cureus.78334. eCollection 2025 Feb.
Previous studies have shown that thrombi, upon retrieval, sometimes exhibit calcification and endothelialization, indicating that they are old, and they can be classified as red clots, white clots, or mixed clots according to the degree of heterogeneity of the thrombus. These findings suggest that, prior to the occurrence of acute myocardial infarction (AMI) and acute ischemic stroke (AIS), such large and heterogeneous thrombi may already be present. Pulmonary vein thrombi (PVTs) are common in patients with age-related diseases. During lung infection, neutrophil extracellular traps (NETs) are generated and have the potential to form thrombi. We previously reported that warfarin and novel oral anticoagulants (NOACs) can partially resolve PVTs, indicating that PVTs are heterogeneous. However, it is unclear whether PVTs contain areas of calcification. In the present case, we describe a patient with left atrium (LA) thrombi extending from PVTs that contained calcifications according to cardiac computed tomography (CT) and transesophageal echocardiography (TEE). On these imaging modalities, the calcifications of the extended LA thrombi appeared as white areas and white areas with white shadows, respectively. Some thrombi, including calcifications, can be resolved with dabigatran, whereas others cannot, indicating that thrombi, including calcifications, are heterogeneous. The effects of microclots, including NETs released from PVTs, have been well studied, and NETs have been reported to be related to many diseases. Treatments for PVTs also produce beneficial effects against these diseases; however, the direct effects of PVTs on the heart and lungs are not well known.
以往研究表明，血栓取出时有时会出现钙化和内皮化，这表明它们形成时间较长，并且根据血栓的异质性程度可分为红色血栓、白色血栓或混合血栓。这些发现提示，在急性心肌梗死（AMI）和急性缺血性卒中（AIS）发生之前，可能已经存在如此大且异质的血栓。肺静脉血栓（PVT）在患有与年龄相关疾病的患者中很常见。在肺部感染期间，会产生中性粒细胞胞外陷阱（NET），其有可能形成血栓。我们之前报道过华法林和新型口服抗凝药（NOAC）可部分溶解PVT，这表明PVT具有异质性。然而，尚不清楚PVT是否包含钙化区域。在本病例中，我们描述了一名患者，其左心房（LA）血栓从PVT延伸，根据心脏计算机断层扫描（CT）和经食管超声心动图（TEE）显示该血栓含有钙化。在这些成像方式下，延伸的LA血栓钙化分别表现为白色区域和带有白色阴影的白色区域。一些包括钙化的血栓可用达比加群溶解，而另一些则不能，这表明包括钙化的血栓是异质的。对包括从PVT释放的NET在内的微血栓的影响已进行了充分研究，并且据报道NET与许多疾病有关。针对PVT的治疗对这些疾病也有有益效果；然而，PVT对心脏和肺部的直接影响尚不清楚。
