栓塞性心肌梗死：揭示一种隐匿的、危及生命的疾病。
Embolic Myocardial Infarction: Unveiling a Hidden, Life-Threatening Disorder.
作者信息
AlTermanini Mohammad, Alqalalwah Adalah, AlAasmi Shabib, Abdullatef Waleed K, Al-Hijji Mohammed, ALQahtani Awad, Abdelghani Mohamed Salah
机构信息
Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
出版信息
JACC Case Rep. 2025 Aug 6;30(22):104630. doi: 10.1016/j.jaccas.2025.104630.
BACKGROUND
The simultaneous occurrence of pulmonary embolism (PE) and myocardial infarction due to a paradoxical embolism through a patent foramen ovale (PFO) is a rare but potentially life-threatening clinical condition. We present an exceptionally rare case of concomitant ST-segment elevation myocardial infarction (STEMI) and acute PE in a young patient with a large PFO, which ultimately led to the diagnosis of an underlying malignancy.
CASE SUMMARY
A 36-year-old woman presented with lateral STEMI. Coronary angiography revealed a large thrombus in a left circumflex artery without atherosclerosis. Transthoracic echocardiography revealed reduced right ventricle function and PFO with a right-to-left shunt. CT pulmonary angiogram confirmed bilateral PE. Further investigation revealed a mass in the left distal femur, diagnosed as myxoid sarcoma via biopsy.
DISCUSSION
This case highlights the importance of considering embolic sources in young patients with STEMI, especially when no significant coronary artery disease is found.
背景
通过卵圆孔未闭（PFO）发生反常栓塞同时并发肺栓塞（PE）和心肌梗死是一种罕见但可能危及生命的临床情况。我们报告了一例极为罕见的病例，一名患有大型PFO的年轻患者同时发生ST段抬高型心肌梗死（STEMI）和急性PE，最终诊断出潜在的恶性肿瘤。
病例摘要
一名36岁女性出现侧壁STEMI。冠状动脉造影显示左旋支动脉有一个大血栓，无动脉粥样硬化。经胸超声心动图显示右心室功能降低以及存在PFO并伴有右向左分流。CT肺动脉造影证实双侧PE。进一步检查发现左股骨远端有一个肿块，经活检诊断为黏液样肉瘤。
讨论
该病例强调了在无明显冠状动脉疾病的年轻STEMI患者中考虑栓子来源的重要性。
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