Streuli R A, Laissue J A
Medizinische Poliklinik, Universität Bern.
Praxis (Bern 1994). 1998 May 13;87(20):694-9.
A 65 year old female developed right thoracic pain, productive cough and fever four weeks after hemicolectomy because of a cancer of the sigmoid. In spite of antibiotic treatment the condition of the patient deteriorated and she was admitted to the hospital with pneumonia of an upper lobe. Chest X-ray visualized prominent proximal pulmonary arteries. Progressive respiratory failure developed and blood gas analysis revealed hypocapnic hypoxemia. The patient had to be intubated and ventilated mechanically. Later, left arm blood pressure measurements could no longer be taken and the radial pulse was missing. Thereafter, an ischemic syndrome of the right leg developed. Embolectomy from the superficial femoral artery was carried out the same day. The patient died five days later. Autopsy revealed an almost complete occlusion of the pulmonary arteries. The organization of thrombotic material indicated recurrence. Emboli were also found in the systemic circulation. A large patent foramen ovale together with signs of pulmonary arterial hypertension are indicative of paradoxical thromboembolism.
一名65岁女性在因乙状结肠癌行半结肠切除术后四周出现右胸痛、咳痰和发热。尽管接受了抗生素治疗，患者病情仍恶化，因上叶肺炎入院。胸部X光显示近端肺动脉突出。出现进行性呼吸衰竭，血气分析显示低碳酸血症性低氧血症。患者不得不进行气管插管并接受机械通气。后来，无法再测量左臂血压，桡动脉搏动消失。此后，右腿出现缺血综合征。当天对股浅动脉进行了栓子切除术。患者五天后死亡。尸检显示肺动脉几乎完全闭塞。血栓物质的机化表明复发。在体循环中也发现了栓子。一个大的卵圆孔未闭以及肺动脉高压的迹象提示反常性血栓栓塞。
