CT血管造影在检测肺栓塞患者即将发生的反常栓塞中的重要性。
The Importance of CT Angiography in Detecting Impending Paradoxical Embolism in Patients With Pulmonary Embolism.
作者信息
Yamazaki Yoshito, Tanaka Yoshiro, Uno Goki, Kashiwagi Yusuke, Kunihara Takashi, Yoshimura Michihiro
机构信息
Division of Cardiology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.
Division of Cardiology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.
出版信息
JACC Case Rep. 2025 Jul 9;30(18):103996. doi: 10.1016/j.jaccas.2025.103996.
BACKGROUND
Impending paradoxical embolism (IPDE) is a rare and life-threatening condition associated with pulmonary embolism (PE). CT angiography (CTA) allows adequate visualization of PE and right ventricular dilatation; however, the usefulness of CTA in detecting IPDE remains unknown.
CASE SUMMARY
We report the case of a patient with IPDE confirmed with CTA after admission. He was successfully treated with surgical thrombectomy and direct closure of the patent foramen ovale (PFO).
DISCUSSION
We highlight the importance of careful and early investigation of underlying IPDE with the use of CTA in patients with PE.
TAKE-HOME MESSAGES: CTA is a useful imaging modality for detecting IPDE even when transthoracic echocardiography cannot detect it. Surgical thrombectomy and direct closure of the PFO may be useful strategies to prevent further major thromboembolisms in cases with a high risk of embolism.
背景
即将发生的矛盾栓塞（IPDE）是一种与肺栓塞（PE）相关的罕见且危及生命的疾病。CT血管造影（CTA）能够充分显示PE及右心室扩张；然而，CTA在检测IPDE方面的效用仍不明确。
病例摘要
我们报告一例患者，入院后经CTA确诊为IPDE。他通过手术取栓及直接闭合卵圆孔未闭（PFO）获得成功治疗。
讨论
我们强调对于PE患者，利用CTA仔细并早期排查潜在IPDE的重要性。
要点
即使经胸超声心动图无法检测到IPDE，CTA仍是检测IPDE的一种有用的成像方式。对于具有高栓塞风险的病例，手术取栓及直接闭合PFO可能是预防进一步严重血栓栓塞的有效策略。
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