Ogura T, Abe T, Takada N, Katagiri M, Tomita T
Department of Medicine, School of Medicine, Kitasato University, Kanagawa, Japan
Nihon Kyobu Shikkan Gakkai Zasshi. 1996 Feb;34(2):194-9.
A 32-year-old woman was hospitalized with recurrent left-sided chest pain and dyspnea on exertion, which had progressed for approximately 10 years. Since age 18 she had been spending more than twelve hours per day in a predominantly seated position on a floor mat, engaged in Japanese dressmaking. A chest roentgenogram showed marked dilation of the main pulmonary arteries, bilateral oligemia in the upper lung fields and a peripheral infiltration in the middle field of the left lung. The (99m)Tc-MAA perfusion lung scan showed multiple defects in both lungs, but no abnormal findings were detected on a 133Xe ventilation scan. A pulmonary angiogram showed multiple occlusions of pulmonary arteries in both lungs. Because recurrent chest pain and dyspnea had been present for a long time, and because ultrasonic cardiography revealed pulmonary hypertension repeatedly for several years, pulmonary thromboembolism was considered to be chronic and recurrent. The patient had none of the following risk factors for pulmonary emboli: malignancy, neurological disease, heart disease, obesity, pregnancy, or a congenital coagulative abnormality such as deficiency of AT-III, protein C, protein S, or plasminogen. Because no other cause could be found, the chronic recurrent pulmonary thromboembolism most likely resulted from extensive sedentary work that caused stagnation of venous return and deep vein thrombosis.
一名32岁女性因反复左侧胸痛和劳力性呼吸困难入院，症状已持续进展约10年。自18岁起，她每天花费超过12小时主要坐在地垫上从事日本裁缝工作。胸部X线片显示主肺动脉明显扩张，双上肺野缺血，左肺中野有外周浸润影。锝-99m标记的大聚合人血清白蛋白（99mTc-MAA）肺灌注扫描显示双肺多处缺损，但氙-133（133Xe）通气扫描未发现异常。肺血管造影显示双肺多处肺动脉闭塞。由于长期存在反复胸痛和呼吸困难，且超声心动图显示肺动脉高压持续数年，故考虑为慢性复发性肺血栓栓塞症。该患者不存在以下肺栓塞危险因素：恶性肿瘤、神经系统疾病、心脏病、肥胖、妊娠或先天性凝血异常，如抗凝血酶III、蛋白C、蛋白S或纤溶酶原缺乏。由于未发现其他病因，慢性复发性肺血栓栓塞症很可能是由于长期久坐导致静脉回流淤滞和深静脉血栓形成所致。
