巨大子宮腺筋症に起因した急性肺血栓塞栓症の1例

Surgical Thrombectomy for Acute Massive Pulmonary Thromboembolism Induced by Giant Adenomyosis Uteri：Report of a Case

はじめに　重症肺血栓塞栓症（PTE）は，大量の血栓に起因した主肺動脈の急性高度狭窄により重症の低酸素血症をきたすとともに，急激な右心後負荷の上昇により右心不全から循環破綻にいたる重篤な疾患である．

A 52-year-old woman had giant adenomyosis uteri treated by pseudo-menopause therapy. However, she did not take oral anticoagulant for deep vein thrombosis prevention because of metrorrhagia. She developed pulmonary thromboembolism, and was refered to our department. She complained mild dyspnea but free from leg edema. Enhanced computed tomography （CT） showed massive thrombi in the central pulmonary artery trunk. Therefore, she underwent emergency thrombectomy. Three days later, uterine artery embolization （UAE） was performed to control metrorrhagia worsened by anticoagulation therapy. However, UAE caused significant swelling of the uterus, and bi-lateral external iliac veins were more compressed. Two months later, total hysterectomy was performed to prevent recurrence of pulmonary thromboembolism （PTE）. Clinical course thereafter was satisfactory.