左肺上区切除後の肺静脈断端血栓により多臓器血栓塞栓症をきたした1例

Multiorgan Thromboembolism due to Thrombus in the Remnant Superior Pulmonary Vein After Left Upper Division Segmentectomy：Report of a Case

はじめに　肺切除後の肺静脈断端血栓症は全身の血栓塞栓症につながる可能性のある合併症であり，特に左上葉切除後に多いとされている．われわれは，比較的報告の少ない左上区切除後の肺静脈断端血栓症の1例を経験したので報告する．

A 67 years old male had underwent left upper division segmentectomy. On the sixth day after surgery, he had developed unconsciousness, aphasia and unilateral spatial neglect. Brain MRI revealed a cerebral infarction, and percutaneous cerebral thrombectomy was performed. Enhanced computed tomography revealed thrombus formation in the remnant superior pulmonary vein （SPV）, left renal infarction and right acute limb ischemia. After starting anticoagulant therapy with apixaban the thrombus reduced and neurological symptoms improved. A thrombus in the SPV may cause serious whole body organ infarction in the same way as a left atrial thrombus. It was suggested that left upper division segmentectomy was associated with the risk of remnant pulmonary vein thrombosis.