右房内巨大浮遊血栓の1例

Giant Floating Thrombus in the Right Atrium：Report of a Case

はじめに　肺血栓塞栓症を伴う右房内浮遊血栓は予後がわるいにもかかわらず，明確な治療方法は確立されていない．われわれは肺血栓塞栓症を合併した右房内巨大浮遊血栓に対して右房内血栓を外科的に摘除し，肺血栓塞栓症に対しては抗凝固療法を行うことで良好な経過を得た1例を経験したので報告する．

Right atrial thrombus with pulmonary thromboembolism is a fatal condition. A 70-year-old woman was transferred to our hospital after echocardiography revealed a large mass in the right atrium. The patient’s vital signs were stable, but blood tests indicated disseminated intravascular coagulation （DIC）. Contrast-enhanced computed tomography （CT） revealed thrombi in the bilateral pulmonary arteries, inferior vena cava, and right common iliac vein. A contrast defect in the right atrium was also observed, suggesting a thrombus. Transthoracic echocardiography revealed a 16-×39-mm floating mass in the right atrium. The patient was diagnosed with a giant floating thrombus in the right atrium complicated by pulmonary embolism and underwent emergency surgery to remove the thrombus. Postoperatively, anticoagulant therapy was administered for the pulmonary thromboembolism. The patient’s recovery was uneventful, with no complications. Surgical resection was deemed the optimal treatment because of the high risk of secondary embolism and the patient’s DIC status.