長期の抗凝固療法によって消褪した広範囲肺血栓症の1例

A Case of Massive Pulmonary Thromboembolism Dissolving After Long-term Anticoagulant Therapy

　肺血栓塞栓症（以下PTE）は，疑うことから診断が始まり，辛抱強く治療することが重要といわれている．われわれは巨大PTE患者に1年間以上の抗凝固療法を施行し，血栓の消槌過程を造影CTで観察した．患者は73歳の男性で，体動時の動悸・息切れ・意識混濁があり外来受診した．低酸素血症・心電図の右脚ブロック・心エコーの著明右心負荷所見よりPTEと診断し組織plasminogen activater（tPA，GRTPA^®）投与を行ったところ，自他覚所見は改善した．後日施行した造影CTと肺動脈造影，肺換気血流シンチで右肺動脈幹にまたがる巨大PTEと確診した．tPAに引き続きheparinを，その後外来ではwarfarinによる治療を約1年間継続し，造影CTで徐々に血栓が縮小していく経過を観察し得た．本例は，急性期を過ぎたPTEであっても根気強く内科的治療を継続することによって血栓が消褪することを改めて示唆したものといえる．

It is important to identify pulmonary thromboembolism (PTE) in the early stage of the disease and to treat patients thoroughly for a long time. We report here a 73-year-old male who received long-term anticoagulant therapy because he was diagnosed as PTE. The patient was admitted for further examination because of dyspnea and disturbance of consciousness on effort. Although he was diagnosed as massive PTE after the acute phase, on the basis of hypoxia, complete right bundle branch blocking on the electrocardiogram and severe right ventriclar overload demonstrated by doppler echocardiography, the patient's condition improved after application of tissue plasminogen activator (tPA, GRTPA^®). Thrombolysis was confirmed by enhanced computed tomography after anticoagulant therapy for more than one year. When managing this disease, it should be kept in mind that some cases of PTE, unless they are in the acute phase of the disease, show good prognosis when treated with anticoagulant therapy for a long time, as evidenced by the case presented here.