卵巣癌破裂後に発症した急性肺動脈血栓塞栓症の１例

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  • A Case of Acute Pulmonary Artery Embolism Secondary to Ruptured Ovarian Adenocarcinoma.

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A 40-year-old woman presented with sudden onset of lower abdominal pain followed by severe dyspnea. Abdominal CT scan revealed an ovarian tumor. Pulmonary artery embolism (PE) was suspected due to tachypnea, a decline of blood pressure and jugular vein distention. PE was confirmed by pulmonary arteriography. On the same day, tissue plasminogen activator (tPA) was selectively administrated into the pulmonary artery through a Swan-ganz catheter, and heparin was administrated continuously to ensure anticoagulation. On the following day, the ovarian tumor was removed by a left adnexectomy because the clinical signs improved. Histology of the ovarian tumor showed clear cell ovarian adenocarcinoma. Because thrombosis was detected by venography and a pulmonary perfusion scan revealed no perfusion defects after the selective infusion of tPA and anticoagulant therapy, the PE secondary to the ruptured ovarian tumor was believed to have been caused by deep venous thrombosis resulting from compression of the inferior vena cava by the ovarian tumor. Though we had difficulty in giving the priority to either a pertinent course of clinical therapy, thrombolytic therapy, or an operation for the ovarian tumor, the postoperative course was uneventful.

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