右房内に血栓を認めた肺血栓塞栓症の1例

A Case Report of Pulmonary Embolism with Right Atrial Thrombus

要旨　肺血栓塞栓症は本邦において高齢化，生活習慣の変化，診断能の向上により増加してきている．急性肺血栓塞栓症の予防，治療にはそのガイドラインも作成され，次第に浸透してきている．急性肺血栓症の一部に右房内血栓を伴うものがあり，その治療法については確立されていない．今回われわれはstage Ⅳの胃癌にて右房内血栓を伴う急性肺血栓症の症例を経験した．症例は62歳女性，外来にて化学療法中，胸痛，労作時呼吸困難にて当院受診し右房内血栓を伴う急性肺血栓塞栓症と診断された．開心術や血栓溶解療法は原疾患のため施行せず，抗凝固薬とIVCフィルターにて保存的加療を行い軽快退院した．右房内血栓についてはその形態が病態，予後に影響を与えるという報告もあり今後の診療の参考になると考えられた．

　Recently, pulmonary emboli have substantially increased with aging, changes in one's lifestyle and improvement in the diagnostic maneuvers. Accordingly, the guidelines for the prevention and treatment of pulmonary thromboemboli have been constructed and have become widely accepted in the real world. Although right atrial thrombi are occasionally incorporated with pulmonary thrombosis, the therapeutic strategy to treat them has not been established. We report a case with a pulmonary embolism incorporated with a right atrial thrombus during the follow-up of stage Ⅳ stomach cancer. A62 year-old woman had chest pain and dyspnea during chemotherapy for stomach cancer at a medical clinic. She was diagnosed with an acute pulmonary embolism with a right atrial thrombus. Open-heart surgery or thromboclasis therapy was considered a treatment but was not performed because of an underlying disease. She was given a conservative medical treatment consisting of anticoagulants and an IVC filter. The therapy made her condition better and she was discharged from our hospital. Since the formation of the right atrial thrombus was suggested to be a contributor to the patient's condition and prognosis, this case report provides insight into understanding such patients with a pulmonary embolism and right atrial thrombus.