Breuer H W, Curtius J M, Goeckenjan G, Jehle J, Worth H, Feiden W, Hort W
Z Kardiol. 1984 Apr;73(4):237-41.
After fracture of his toes, a 34-year-old male patient developed deep leg vein thrombosis and subsequent pulmonary embolism. Because of progressive heart enlargement, 2D-echocardiography was performed. A floating mass measuring 4.5 cm X 3.5 cm was found in the right ventricle. On account of the deep leg vein thrombosis and the lung perfusion deficits detected by scintigraphy, the floating mass was thought to be a thrombus. Because of the severity of the patient's state and the lack of success of a heparin therapy with 32,000 IU/d, fibrinolytic treatment with streptokinase was started. After initial improvement in pulmonary gas exchange the patient died about 7 hours later from progressive cardiopulmonary insufficiency. Necropsy revealed a smaller right ventricular thrombus than that seen by echocardiography. There were typical surface erosions caused by the fibrinolytic treatment. Many younger and older emboli which in part were fragmented could be shown in the pulmonary vessels. A fragmentation of the right ventricular thrombus and subsequent lethal occlusion of pulmonary vessels had to be considered. With respect to the course of the described case and some case reports in the literature we think fibrinolysis is more dangerous than surgical thrombectomy in right ventricular thrombosis.
一名34岁男性患者脚趾骨折后发生下肢深静脉血栓形成及随后的肺栓塞。由于心脏逐渐增大，进行了二维超声心动图检查。在右心室发现一个大小为4.5 cm×3.5 cm的漂浮物。鉴于下肢深静脉血栓形成及通过闪烁扫描检测到的肺部灌注缺损，该漂浮物被认为是血栓。由于患者病情严重且每日32,000 IU肝素治疗未成功，开始用链激酶进行溶栓治疗。肺气体交换初步改善后，患者约7小时后死于进行性心肺功能不全。尸检显示右心室血栓比超声心动图所见的小。有溶栓治疗引起的典型表面糜烂。在肺血管中可见许多大小不一、部分已破碎的栓子。必须考虑右心室血栓破碎及随后肺血管致命性阻塞的情况。就所述病例的病程及文献中的一些病例报告而言，我们认为在右心室血栓形成中，溶栓比手术取栓更危险。
