| A Surgical Case of Acute Pulmonary
Thromboembolism with Multiple Mononeuritis |
(The Second Department of Surgery, Shinshu University
School of Medicine, Matsumoto, Japan)
| Tsuneo Nakajima |
Hirofumi Nakano |
Kuniyoshi Watanabe |
| Tamaki Takano |
Ryo Hasegawa |
Hirohisa Goto |
| Hiroto Kitahara |
Hideo Kuroda |
Jun Amano |
|
The patient was a 63-year-old man
with a history of multiple mononeuritis with hypergammaglobulinemia
since 1980. The symptoms gradually worsened, and he had been
bed-ridden since 1992. On February 28, 1997, he had sudden dyspnea
after defecation. Echocardiography demonstrated a large thrombus
in the right atrium and the right ventricle. Enhanced chest computed
tomography revealed thrombi in the bilateral pulmonary arteries.
The patient was considered to have acute pulmonary thromboembolism,
and an emergency operation was indicated. Thrombectomy was performed
under extracorporeal circulation through a median sternotomy.
No thrombi were found in the right atrium or the right ventricle,
and thrombi in the bilateral pulmonary arteries were removed
completely. Four days after the operation, a Greenfield filter
was implanted in the vena cava inferior because venography detected
a thrombus in the right common iliac vein. The postoperative
course was uneventful. No pulmonary rethromboembolisms were noticed
after the operation. The long duration of being bed-ridden seemed
to be the chief cause of thrombosis in the deep veins, and hyperviscosity
due to hypergammaglobulinemia may have caused hyperthrombogenicity.
Jpn. J. Cardiovasc. Surg. 30: 314-316(2001) |
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