肺塞栓症で発症したPaget-Schroetter症候群（原発性鎖骨下静脈血栓症）の1例

Pulmonary Embolism Caused by Paget-Schroetter Syndrome without Upper Extremity Symptoms. Case Report

　Paget-Schroetter症候群は，静脈還流障害による上肢症状を主とした鎖骨下静脈の血栓症であるが，整形外科領域での報告は少ない．われわれは，上肢症状を欠き肺塞栓症で発症した稀な1例を経験した．症例は16歳の男性である．誘因なく血痰と胸痛が出現し，肺塞栓症と診断された．静脈造影とMR-アンギオグラフィで，右鎖骨下静脈の血栓と上肢外転外旋位での静脈圧迫を認めた．治療は，抗凝固療法と右第1肋骨切除術を行った．術後2年8カ月の時点では，症状の再発は認められない．本症の治療には，第1肋骨切除術が有効と考えられた．

　A 16-year-old male had experienced bloody phlegm and chest pain for three months before presentation without cause. He was diagnosed as having pulmonary embolism with Tc-99m MAA pulmonary perfusion scintigraphy. At the first examination, he had no abnormal clinical findings or a hematological examination without positive Roos's test for thoracic outlet syndrome at the right upper extremity. Deep venous thrombosis of the right upper extremity was suspected. Venography and MR-angiography revealed a thrombosis of the right subclavian vein with greater compression in the upper extremity in the elevated position. The patient was diagnosed as having Paget-Schroetter syndrome and was treated with an anticoagulate regimen and first rib resection. At three months after the operation, venography revealed complete resolution of the venous thrombosis. For 32 months after the operation, there was no recurrence of pulmonary embolism. First rib resection is among the curative surgical treatments for this disease.