超音波カラードプラ法が有用であった原発性鎖骨下静脈血栓症例

Validity of Color Doppler Ultrasonography in a Patient with Subclavian Vein Effort Thrombosis

　患者は22歳，女性．労作後に右上肢の進行性腫脹を来して来院．超音波カラードプラ法で右鎖骨下静脈血流の血栓による途絶が疑われたため，静脈造影を施行した．原発性鎖骨下静脈血栓症（Paget-Schroetter症候群）の診断にて，ヘパリンとウロキナーゼを投与し，引き続きワーファリンを開始した．カラードプラ法を用いた経過観察では，6日後には血栓内に血流が再開し，14日後には血栓像は消失したが静脈壁の肥厚が観察された．これらの所見に伴い次第に右上肢腫脹は軽快した．肢位による血流変化では，上肢の外転・外旋につれて鎖骨下静脈は圧迫閉塞されたが，さらなる過外転・過外旋位ではむしろ血流は再開した．同様の所見は再検時の静脈造影でも確認された．超音波カラードプラ法は，本症の診断，治療経過の観察，および鎖骨下静脈の閉塞を来す肢位の同定に有用であった．

A 22-year-old woman was admitted to our hospitalbecause of progressive swelling of right upper limb afterexertion. Color Doppler ultrasonography showed anabsence of blood flow signal in the right subclavian-vein. Diagnosis of subclavian-vein effort thrombosiswas confirmed by venography. Heparin, urokinase andwarfarin were administered with a relief of her symp-tom. Follow-up color Doppler examination revealedpartial reperfusion six days later and complete lysis ofthe thrombus with thickened venous wall 14 days later.Provocative test of thoracic-outlet syndrome was per-formed using color Doppler ultrasonography. The rightsubclavian-vein was compressed with gradual abduc-tion and external rotation of her right upper limb, butvenous flow emerged with hyper-abduction and externalhyper-rotation. Color Doppler ultrasonography was,therefore, valid in diagnosis, follow-up, and determina-tion of the limb position at risk in a patient with sub-clavian-vein effort thrombosis.