The Korean Journal of Medicine

  • 제81권4호
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  • Pages.496-501
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  • 2011
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  • 1738-9364(pISSN)
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  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지

우좌 단락 없이 관상동맥 색전증과 폐동맥색전증이 동시에 발생한 1예

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

  • 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)
  • 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)
  • 발행 : 2011.10.01
⟨ 이전 논문 다음 논문 ⟩

초록

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.

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.

키워드

참고문헌

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