The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지

Concurrent Coronary Thromboembolism and Pulmonary Thromboembolism without Right-to-Left Shunt

우좌 단락 없이 관상동맥 색전증과 폐동맥색전증이 동시에 발생한 1예

  • Lee, Min-Young (Division of Cardiology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Yoon, Duck-Hyoung (Division of Cardiology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Lee, Chan-Woo (Division of Cardiology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Park, Kyu-Tae (Division of Cardiology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Ryu, Myeong-Shin (Division of Cardiology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Choi, Hyun-Hee (Division of Cardiology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Hong, Kyung-Soon (Division of Cardiology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine)
  • 이민영 (한림대학교 의과대학 춘천성심병원 순환기내과) ;
  • 윤덕형 (한림대학교 의과대학 춘천성심병원 순환기내과) ;
  • 이찬우 (한림대학교 의과대학 춘천성심병원 순환기내과) ;
  • 박규태 (한림대학교 의과대학 춘천성심병원 순환기내과) ;
  • 유명신 (한림대학교 의과대학 춘천성심병원 순환기내과) ;
  • 최현희 (한림대학교 의과대학 춘천성심병원 순환기내과) ;
  • 홍경순 (한림대학교 의과대학 춘천성심병원 순환기내과)
  • Published : 2011.10.01
⟨ Previous Next ⟩

Abstract

A 65-year-old woman was referred for management of chest pain and ST segment elevation on electrocardiography. Emergency coronary angiography revealed a well demarcated thrombus that near totally occluded the mid portion of the left anterior descending artery, with a Thrombolysis In Myocardial Infarction (TIMI) flow grade 1, and a fusiform aneurysm on the left main coronary artery. No significant stenosis was observed after aspiration of the thrombus; however, complete coronary reperfusion by urgent aspiration did not improve her dyspnea and tachypnea. Echocardiography revealed a D-shaped left ventricle; thus, we performed a chest computed tomography scan and diagnosed a pulmonary embolism. The patient's coagulation studies were normal. She was prescribed chronic anticoagulation, and we carried out transthoracic echocardiography using second harmonic imaging with agitated saline. Second harmonic imaging with the Valsalva maneuver revealed no right-to-left shunt. We report here a case of concurrent coronary embolism and pulmonary embolism without right-to-left shunt.

본 증례는 급성 심근경색으로 내원한 환자의 혈관조영술에서 좌주관상동맥류와 함께 관상동맥 혈전색전이 확인되었던 환자로 관동맥 재관류 치료 후에도 증상 및 징후의 호전이 없고 심초음파 검사에서 폐색전증이 의심되는 소견이 관찰되었으며, 흉부 컴퓨터 단층촬영에서 폐색전증이 발견되었다. 이 환자는 응고장애나 다른 검사에서 특이사항이 없었으며 경흉부 심초음파 하모닉 영상에서 우좌 단락을 시사하는 소견은 보이지 않았다. 우좌 단락 없이 관상동맥과 폐동맥에 동시에 색전증이 발생된 증례로 현재까지 보고된 바가 없어 문헌고찰과 함께 보고하는 바이다.

Keywords

References

  1. Hernandez F, Pombo M, Dalmau R, et al. Acute coronary embolism: angiographic diagnosis and treatment with primary angioplasty. Catheter Cardiovas Interv 2002;55:491-494. https://doi.org/10.1002/ccd.10122
  2. Daoud AS, Pankin D, Tulgan H, Florentin RA. Aneurysms of the coronary artery: report of ten cases and review of literature. Am J Cardiol 1963;11:228-237. https://doi.org/10.1016/0002-9149(63)90064-X
  3. Ercan E, Tengiz I, Yakut N, Gurbuz A. Large atherosclerotic left main coronary aneurysm: a case report and review of literature. Int J Cardiol 2003;88:95-98. https://doi.org/10.1016/S0167-5273(02)00377-7
  4. Wilson GT, Schaller FA. Pulmonary embolism mimicking anteroseptal acute myocardial infarction. J Am Osteopath Assoc 2008;108:344-349.
  5. Park YS, Ha JW, Kwon KW, et al. Clinical characteristics and predictors of in-hospital mortality for patients with acute major pulmonary embolism. Korean J Med 2000;58:293-300.
  6. Lim CM, Lee SS, Song KS, et al. The value of spiral computed thomography in the diagnosis of pulmonary embolisml. Korean J Med 1997;53:787-794.
  7. Kim CJ. Images in medicine: thrombus in right ventricular cavity in pulmonary thromboembolism. Korean J Med 2004;66:555-556.
  8. Konstantinides S. Clinical practice: acute pulmonary embolism. N Engl J Med 2008;359:2804-2813. https://doi.org/10.1056/NEJMcp0804570
  9. Cakir O, Ayyildiz O, Oruc A, Eren N. A young adult with coronary artery and jugular vein thrombosis: a case report of combined protein S and protein C deficiency. Heart Vessels 2002;17:74-76. https://doi.org/10.1007/s003800200047
  10. Melhem A, Desai A, Hofmann MA. Acute myocardial infarction and pulmonary embolism in a young man with pernicious anemia-induced severe hyperhomocysteinemia. Thromb J 2009;7:5. https://doi.org/10.1186/1477-9560-7-5
  11. Haghi D, Sueselbeck T, Papavassiliu T, Haase KK, Borggrefe M. Paradoxical coronary embolism causing non-ST segment elevation myocardial infarction in a case of pulmonary embolism. Z Kardiol 2004;93:824-828. https://doi.org/10.1007/s00392-004-0130-0
  12. Meier-Ewrt HK, Labib SB, Schick EC, Gossman DE, Stix MS, Williamson CA. Paradoxical embolism in the left main coronary artery: diagnosis by transesophageal echocardiography. Mayo Clin Proc 2003;78:103-106. https://doi.org/10.4065/78.1.103
  13. Kim ES, Kim SH, Hur JW, et al. A case of impending paradoxical embolus in a patient with acute pulmonary embolism. J Korean Soc Echocardiogr 2002;10:101-105.
  14. Shin MS, Kang SM, Jang KJ, et al. Clinical utility of harmonic imaging in the detection of right to left shunt through patent foramen ovale by transthoracic contrast echocardiography. Korean Circ J 2000;30:433-439. https://doi.org/10.4070/kcj.2000.30.4.433