The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Massive Pulmonary Embolism with Thrombus-in-Transit Entrapped by a Patent Foramen Ovale

난원공개존에 걸린 이행성 혈전을 동반한 광범위 폐색전증 1예

  • Oh, Ju Yeon (Department of Internal Medicine, National Cancer Center) ;
  • Lee, Woo Jin (Center for Liver Cancer, National Cancer Center) ;
  • Kim, Hak Jin (Department of Cardiology, Center for Clinical Specialty, National Cancer Center)
  • 오주연 (국립암센터 내과) ;
  • 이우진 (국립암센터 간암센터) ;
  • 김학진 (국립암센터 지원진료센터 심장내과)
  • Received : 2017.06.14
  • Accepted : 2017.08.22
  • Published : 2018.02.01
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Abstract

"Thrombus-in-transit" in pulmonary embolism is associated with high mortality and refers to a free-floating clot in the right atrium or right ventricle, indicating that deep vein thrombosis is present en route to the pulmonary artery. Thrombus entrapped in a patent foramen ovale (PFO) is a rare condition and is associated with paradoxical systemic embolism. Here, we report a case of acute pulmonary embolism with thrombus-in-transit through a PFO in a 68-year-old woman with a diagnosis of metastatic pancreatic cancer undergoing palliative chemotherapy. She presented with syncope after acute onset of exertional dyspnea and was diagnosed with cardiogenic shock due to massive pulmonary embolism with thrombus-in-transit on admission to the emergency room. We treated her with systemic thrombolysis and anticoagulation therapy instead of surgical thrombectomy. We show that hemodynamically unstable pulmonary embolism with thrombus-in-transit entrapped by a PFO may be successfully treated with systemic thrombolysis without paradoxical embolism.

난원공개존에 걸린 이행성 혈전을 동반한 광범위 폐색전증은 드물게 발생하지만 발생시 높은 사망률을 보인다. 본 증례는 정맥혈전증의 고위험군 환자에서 난원공개존에 걸린 이행성 혈전을 동반한 폐색전증이 발생하였을 때 기이성 색전증 발생 없이 전신성 혈전 용해술로 성공적으로 치료할 수 있음을 보여주는 1예로 문헌고찰과 함께 보고하는 바이다.

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References

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