依诺肝素联合阿司匹林治疗肺栓塞并发腹膜后巨大血肿1例

1病例报告患者,女,77岁。因"反复活动后气促4个月,加重2d"于2007-05-10入院。6年前因"肺肿瘤"行左上肺叶肿瘤剔除术。4个月前曾受凉后出现胸闷、咳嗽、咯痰,痰量多、色白稀、无粉红色泡沫痰,活动后气促,伴有夜间呼吸困难。在当地卫生所就诊,予抗感染及祛痰药治疗,效果欠佳,遂转我院就诊。起病后无突发胸痛、咯血,无非对称性下肢浮肿。     

冠状动脉造影术后并发急性肺血栓栓塞症一例

随着心血管病介入诊断和治疗的广泛开展,介入诊治术后并发急性肺血栓栓塞症(PE)并不少见,本文报导1例急性心肌梗死后冠状动脉(冠脉)造影并发PE。1临床资料患者女性,54岁,因发作性胸痛6年,加重14天入院。既往有高血压病20年,高脂血症10年。入院查体:心肺体检正常。心电图示Ⅰ、a     

Klinefelter综合征并发肺血栓栓塞症一例

患者男性，36岁，因反复意识丧失伴胸痛1d入院。2005年1月30日晨患者起床活动后突发意识丧失，摔倒在地，4h后自行恢复，感胸部闷痛，伴气短、呕吐胃内容物，无头痛、肢体活动障碍和大、小便失禁。     

海绵状心肌病并发肺血栓栓塞症一例

患者女性 ,6 3岁 ,因胸闷、胸痛伴活动后心慌、气促 2月余入院。患者于 2个多月前无诱因出现胸闷、胸痛 ,胸痛呈阵发性 ,与呼吸及体位无关 ,并向后背部放射 ,每次发作持续约数分钟 ,休息和含用硝酸甘油可缓解 ,伴活动后心慌、气促。无咯血及痰中带血 ,无发热、盗汗及咳黄脓痰。到当地医院就诊 ,经心电图、超声心动图及胸部ＣＴ检查 ,诊断为“冠心病、心绞痛、阵发性房颤、心功能Ⅳ级、肺血栓栓塞不除外” ,予低盐低脂饮食 ,吸氧 ,扩张血管 ,改善心肌供血 ,抗凝治疗及对症处理 ,心房颤动转复为窦律 ,但上述症状时有反复。曾予华法林 2 5ｍｇ…     

急性重症肺血栓栓塞症一例

患者女性 ,17岁。因咳嗽、左胸痛、发热 1周于 1997年 5月 13日入院。患者近 2年来月经周期不准 ,且经量或多或少 ,伴有血块。查体 :体温 37 7℃ ,脉搏 10 0次 /ｍｉｎ ,呼吸 2 2次 /ｍｉｎ ,血压 90 / 6 8ｍｍＨｇ(1ｍｍＨｇ =0 133ｋＰａ)。体形消瘦 ,无气急、紫绀 ,左下肺呼吸音偏低 ,余肺呼吸音清晰 ,未闻及胸膜摩擦音 ,心音稍低 ,心律 10 0次 /ｍｉｎ ,律齐 ,未闻及病理性杂音 ,无心包摩擦音。白细胞 2 1 8× 10 9/Ｌ ,中性粒细胞0 6 6 ,淋巴细胞 0 34 ,胸片后前位示 :两下肺淡密度斑片状模糊阴影 ,左肋膈角模糊 (图 1)。胸部Ｂ超示…     

肺血栓栓塞症合并右心房内巨大血栓溶栓一例

大面积肺血栓栓塞症 (PTE)应予溶栓治疗 ,但若合并存在右心内血栓则属溶栓的相对禁忌证。本例在溶栓后再度发生严重呼吸困难 ,应考虑为血栓自右心房或同时从下肢深静脉内脱落所致又一次肺血栓栓塞。此类病例的治疗存在诸多棘手之处 ,需加慎重考虑 ,必要时需请本领域内外科专家会诊 ,以决定一个相对周全的处理方案。     

射频消融术后巨大腹膜后血肿成功救治一例

患者,男,36岁,因"发作性心悸1年"于2010年6月25日入我院.既往无糖尿病、高血压病史,无反复牙龈出血病史.查体:体重71 kg,血压130/80 mm Hg(1 mm Hg=0.133kPa).心、肺、腹部未见异常.血常规、生化及凝血指标正常,心电图示预激综合征(B型).给予阿司匹林100 mg,口服,1次/d.于2010年6月28 日行电生理检查及射频消融术.术前给予普通肝素2000 U静脉注入,术中每小时补充肝素1000 U.常规穿刺颈内静脉和股静脉,分别置入10极冠状静脉窦电极导管和4极希氏束电极导管.电生理检查提示右后游离壁、左后间隔房室旁路(AP).穿刺股动脉(穿刺较为困难,多次穿刺,部分穿刺点可能较高)置入7F动脉鞘,逆行主动脉途径消融无效,后经股静脉途径于心中静脉处标测和消融左后间隔AP成功;并于三尖瓣环7:30处消融右后游离壁AP成功.手术时间约3h,患者术中略烦躁、出汗,但血压、指脉血氧等正常,于15:30返回病房.     

心脏起搏器植入术后并发右室巨大血栓一例

患者男性,60岁,因呼吸困难入院,5个月前行心脏双腔起搏器植入术。超声心动图及肺动脉CTA见右室巨大血栓及右房血栓,予低分子肝素治疗1周后复查超声心动图右室血栓明显减小,抗凝治疗有效。     

老年人急性肺血栓栓塞溶栓成功一例

患者女性,6 3岁。因气短10余天于2 0 0 3年2月12日急诊入院。2 0 0 3年2月1日始因连日劳累感活动后胸闷、气短,持续数小时,休息后缓解。12日症状加重来我院急诊,查心肌酶正常,血糖为10 5mmol/L ,心电图示Ⅱ、V4 5导联T波低平,Ⅲ、aVF、V1 3 导联T波倒置,以胸闷原因待查,急性冠状动脉综合征收入院。既往高血压史15年,血压最高170 / 80mmHg。入院后查体:患者呼吸频率快,32次/min ,颜面及口唇紫绀明显,双肺未闻及干湿性啰音,呼吸困难程度与肺内听诊结果不相符。体胖,血压110 / 85mmHg ,心率10 8次/min ,律齐,P2 >A2 ,各瓣膜听诊区未闻及…     

急性心梗后并发急性动脉栓塞一例

急性心梗后并发急性动脉栓塞一例陆秋芬，赵美华，徐惠芬，杨卫红患者，女５６岁。因心前区压榨性疼痛４小时，ＥＣＧ示急性高侧壁心肌梗塞，肌酸磷酸激酶（ＣＫ）及ＣＫ－ＭＢ升高，诊为急性高侧壁心肌梗塞而入院。体检：能平卧，双肺，心律齐，心率８０次／分，心音低钝...     

Massive pulmonary embolism: a remarkable case and review of treatment

Although the clinical syndrome following pulmonary embolism (PE) may be subtle, in the case of massive PE the severity of the clinical presentation typically makes the picture more obvious. If more than two lobar pulmonary arteries become obstructed, the hemodynamic and respiratory consequences are severe, and may be life threatening. We present an unusual case where a patient experienced transient hemodynamic collapse during valsalva, and a massive saddle pulmonary embolus was discovered incidentally. Current treatment options for massive PE are then discussed.     

Pregnancy and acute pulmonary embolism: a case report

We describe the case of a 37-year-old pregnant woman who presented at 29 weeks of gestation with syncope and shortness of breath caused by pulmonary embolism. Due to persistent hypotension thrombolytic therapy with tenecteplase was administered and the clinical and hemodynamic response was excellent, with no maternal or fetal hemorrhagic complications. The clinical presentation of pulmonary embolism is sometimes camouflaged by the physiological changes that occur in pregnancy and diagnosis is often delayed by reluctance to expose the fetus to ionizing radiation. Systemic thrombolysis is considered a high-risk treatment in pregnancy and very few women have received it. However the complication rates of thrombolytic therapy are acceptable in the light of the underlying disease.     

Impending paradoxical embolism visualized by echocardiography combined with pulmonary embolism: a case report

A 43-year-old man was admitted to our hospital complaining of dyspnea on exertion and dizziness. Transthoracic echocardiography revealed a mobile mass (3.5 x 1.0 cm) attached to the left atrial septum and transesophageal echocardiography showed the mass in the right atrium protruding through the patent foramen ovale into the left atrium. A mobile snake-like thrombus was apparent in the right atrium and right ventricle. The diagnosis was pulmonary embolism with impending paradoxical emboli.     

Massive pulmonary embolism during pregnancy treated with streptokinase and complicated by massive haemorrhage--a case report

A case of a 27-year-old pregnant female (first trimester) is described. The patient was hospitalised due to pregnancy complications and immobilised for 3 weeks. At the end of this period patient's clinical condition rapidly deteriorated and she developed shock, followed by cardiac arrest. Echocardiography was consistent with acute pulmonary embolism and the patient received streptokinase. This treatment was complicated by a massive bleeding due to the rupture of the uterus. She underwent hysterectomy and recovered thereafter.     

Massive pulmonary embolism in a patient with ulcerative colitis and hyperhomocysteinaemia -- a case report

We describe a case of a 37-year-old man with active ulcerative colitis complicated by proximal deep vein thrombosis of the left lower limb and subsequent massive pulmonary embolism requiring mechanical ventilation and catecholamine infusion. In spiral CT a large thrombus obturating left pulmonary artery as well as bilateral embolic material in lobar and segmental branches were visible. Haemodynamic status improved after infusion of rtPA. Haemoglobin decrease (7.0-5.6 mmol/L) was corrected with erythrocyte mass transfusion. During subsequent therapy with intravenous full dose of unfractionated heparin and further long-term treatment with subcutaneous enoxaparin (1.5 mg/kg and after 3 months 1.0 mg/kg daily) haemoglobin value was relatively stable. Underlying disease was treated with 5-ASA (mesalazine) and steroids. Due to hyperhomocysteinaemia (16.0 micromol/L) coexisting with a low plasma folic acid (2.1 ng/ml) and cyanocobalamin (137 pg/ml) levels, supplementation with these vitamins was prescribed. The screening tests for familial thrombophilia (including 677C-->T MTHFR mutation) were negative. The authors discuss the pathogenesis of increased thromboembolic risk in inflammatory bowel disease and therapeutic dilemmas connected with treatment of such complications.     

Bronchial adenocarcinoma mimicking acute pulmonary embolism -- a case report

A case of a 31-year-old male with medical history, clinical symptoms and additional diagnostic tests strongly suggesting diagnosis of acute pulmonary embolism is presented. However, pulmonary emboli were not seen during pulmonary angiography. At autopsy bronchial carcinoma was found and this definitive diagnosis was confirmed by the results of histopathological study.     

Placenta previa totalis complicated with pulmonary embolism during cesarean section: a case report

Venous thromboembolism is believed to be rare in Japan, whereas increases in occurrence of pulmonary embolism have been drawing attention because it has become the most common cause of maternal death in recent years. A 36-year-old woman at 33 weeks of pregnancy was transferred to our hospital because of placenta previa totalis and treated with emergency cesarean section on the same day. Soon after the delivery of the fetus, the patient developed pulmonary embolism. The condition of pulmonary embolism was suspected when abnormal values were noted in respiratory and circulatory parameters and then confirmed by intraoperative transesophageal echocardiography, which revealed a thrombus in the right atrium. Anticoagulant treatment with unfractionated heparin started during the operation caused a tendency to bleed during and after the operation, and subsequently required a second laparotomy to control bleeding. After insertion of an inferior vena cava filter, a third laparotomy was performed to remove a giant hematoma. Heparin discontinuation intended to decrease the tendency to bleed was followed by two recurrences of pulmonary embolism, resulting in a dangerous condition. Despite these difficult complications, our interventions successfully saved the patient's life and restored her health. We report changes observed in her conditions along with treatment and management we provided, and describe the specificity of pulmonary embolism occurring during the operation.     

Caution for acute submassive pulmonary embolism with syncope as initial symptom: a case report

Pulmonary embolism (PE) may escape prompt diagnosis since clinical symptoms and signs are nonspecific. The occurrence of syncope as the sole initial symptom in a previously healthy patient with no predisposing factors to embolism and no hemodynamic instability is extremely rare, which may have been a factor in the delayed diagnosis. We describe a case of acute submassive PE with syncope as the initial symptom. A 62-year-old previously healthy female was admitted to our hospital for transitory episode of syncope. Following admission, chest computed tomography demonstrated embolism in the right main pulmonary and left inferior pulmonary arteries. Following the final diagnosis, the patient was successfully treated with thrombolytic therapy with systemic urokinase. We consider that raised awareness and early diagnosis and treatment were key factors in ensuring a satisfactory prognosis.     

Myocardial injury secondary to acute pulmonary embolism - a case report

A case of a 37-year-old male admitted to the hospital due to dyspnea and chest pain is presented. Electrocardiogram showed negative T waves in V1 and V2 as well as subtle ST segment elevation in all precordial leads. Cardiac enzymes were moderately elevated. The initial diagnosis was myocarditis or acute coronary syndrome, however, transthoracic echocardiography showed a marked right ventricular overload which suggested acute pulmonary embolism. The latter diagnosis was confirmed by transesophageal echocardiography which revealed thrombosis of both left and right pulmonary arteries. The patient received thrombolysis and anticoagulants, and his condition improved. He was discharged home and the course of a six-month follow-up was uneventful.