Cuccia C, Campana M, Centurini P B, Bolognesi R, Costa F, Zogno M
Cattedra e Divisione di Cardiologia, Università degli Studi e Spedali Civili di Brescia.
G Ital Cardiol. 1998 Sep;28(9):1028-31.
The case of a patient affected with acute pulmonary embolism and concomitant cerebral thromboembolism is described. The patient was admitted to our Coronary Care Unit with aphasia and hemiplegia. Five days before, he had undergone a hip replacement. A lung scan showed bilateral embolism; transthoracic echocardiogram revealed signs of pulmonary hypertension and the presence of a large, elongated, highly mobile "in-transit" thrombus entrapped into a patent foramen ovalis, and prolapsing into the right and left ventricle during diastole. The patient underwent surgical removal of the thrombus, with closure of the patent foramen. We did not treat the patient with thrombolysis, fearing the damage that a new embolism might produce. After surgery, the patient had a lengthy hospital stay because of renal failure and infection due to Pseudomonas aeruginosa. The patient was discharged from the hospital three months later on dialytic treatment and although he was still aphasic, there was partial recovery of motor function. Nevertheless, normalization of renal function and regression of aphasia occurred during the following months, with a residual mild motor defect of the right hand. This case report represents a starting point for discussing treatment of "in-transit" thrombi during pulmonary embolism.
本文描述了一例患有急性肺栓塞并伴有脑栓塞的患者。该患者因失语和偏瘫入住我们的冠心病监护病房。五天前，他接受了髋关节置换手术。肺部扫描显示双侧栓塞；经胸超声心动图显示有肺动脉高压迹象，并且存在一个大的、细长的、高度可移动的“移行性”血栓，该血栓被困在卵圆孔未闭处，并在舒张期脱垂至右心室和左心室。患者接受了血栓切除术，并封闭了卵圆孔未闭。由于担心新的栓塞可能造成的损害，我们未对该患者进行溶栓治疗。术后，患者因肾衰竭和铜绿假单胞菌感染而住院时间较长。三个月后，患者在接受透析治疗的情况下出院，尽管仍有失语，但运动功能有部分恢复。然而，在接下来的几个月里，肾功能恢复正常，失语症状消退，仅右手残留轻度运动缺陷。本病例报告是讨论肺栓塞期间“移行性”血栓治疗的一个起点。
