上腕動脈の急性閉塞を契機に発見された上行大動脈内血栓症

Ascending Aortic Thrombus Recognized by Acute Brachial Arterial Occlusion

上行大動脈内血栓症はまれであるが，致命的塞栓症の原因となるため緊急治療が必要となる1）．手術においてもっとも重要な点は，大動脈切開まで血栓を遊離させないことである．われわれは，右上腕動脈の急性閉塞を契機に発見された上行大動脈内血栓症例において，手術操作時や体外循環中の血栓の動向を経食道心エコー（TEE）により監視しながら行い，良好な結果を得たので報告する．

We report a case of ascending aortic thrombus with acute arterial occlusion of the brachial artery. A 49-year-old woman had sudden pain in her right arm due to acute occlusion of the right brachial artery. Contrast-enhanced computed tomography and echocardiography revealed a large mobile thrombus in the ascending aorta, which prompted surgical intervention. The thrombi were removed via aortotomy under circulatory arrest. Trans-esophageal echocardiography was useful for watching a potential detachment of the thrombus in the aorta during surgical manipulations or systemic perfusion. Despite no evidence of either inherited or acquired thrombotic predisposition, thrombosis in the right atrium and deep veins of the lower extremities was found postoperatively. Since antiplatelet and anticoagulant therapy was started, she has suffered from no thrombotic event.