Sal R, Cormier J M, Chapoutot L, Alamé A, al-Khedr A, Raynaud J C, Apparuit J P, Bailly L
Service de cardiologie A, hôpital Corvisart, Charleville-Mézières.
Arch Mal Coeur Vaiss. 1996 Oct;89(10):1317-21.
The authors report the case of a 34-year old woman with no previous cardiovascular disease who was admitted to hospital for acute ischaemia of the right arm due to embolism, preceded by two episodes of pain and tingling of the left arm related to subacute ischaemia. After right embolectomy, with no possibility of controlateral disobliteration an effective anticoagulation, no cardiac source of embolism could be found; However, transoesophageal echography showed a large mobile thrombus in the aortic arch implanted just before the origin of the left subclavian artery. The only explanation for embolism to the right arm was a retro-oesophageal subclavian artery which was confirmed by scanner. Doppler and arteriography. These investigations, however, did not allow visualisation of the aortic thrombus. In view of the risk of recurrent embolism, a thrombectomy was performed without cardiopulmonary bypass, associated with correction of the vascular abnormality with no complications. This case shows that oesophageal echography is a useful investigation in the work up of acute arterial obstruction in young patients with no cardiac disease.
作者报告了一例34岁女性病例，该患者既往无心血管疾病，因栓塞导致右臂急性缺血入院，在此之前有两次与亚急性缺血相关的左臂疼痛和刺痛发作。右上肢取栓术后，由于无法进行对侧血管再通且抗凝效果不佳，未发现心脏栓子来源；然而，经食管超声心动图显示在主动脉弓左锁骨下动脉起始处前方有一个大的活动血栓。右臂栓塞的唯一解释是食管后锁骨下动脉，这一情况经扫描、多普勒检查和动脉造影得以证实。然而，这些检查未能显示主动脉血栓。鉴于有复发栓塞的风险，在未进行体外循环的情况下实施了血栓切除术，并对血管异常进行了矫正，未出现并发症。该病例表明，食管超声心动图在无心脏病的年轻患者急性动脉阻塞的检查中是一项有用的检查手段。
