若年男性の右自然気胸周術期に発症した肺血栓塞栓症の1例 A case of pulmonary thromboembolism developing in a young male patient during surgery for right spontaneous pneumothorax

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<p>症例は19歳,男性.右胸痛と呼吸困難にて近医を受診した.右自然気胸の診断で保存的治療を行ったが改善しないため,本院に転院し手術の方針となった.麻酔導入後,左片肺換気でSpO<sub>2</sub>が70%まで低下した.気管支鏡で分離肺換気用チューブの位置の確認と痰による気管支閉塞がないこと,聴診所見等に異常所見がないことを確認した.分離肺換気に伴う換気血流不均等分布が強く生じていると判断し,左片肺換気に右肺の持続陽圧換気を加えて手術を継続した.しかし,手術を終了し麻酔覚醒後も低酸素血症が持続した.精査にてD-dimerの高値,CTで左主肺動脈に血栓を認め肺血栓塞栓症と診断した.下大静脈フィルターの留置と抗凝固療法で加療し,潜在的な血栓素因の検索でアンチトロンビンIII欠損症が疑われた.若年者であっても肺血栓塞栓症の危険因子が潜在していることがあり,常に肺血栓塞栓症の可能性を留意しておく必要がある.</p>

<p>A 19-year-old man presented at a nearby hospital with right chest pain and dyspnea. He was diagnosed with right spontaneous pneumothorax and treated with pleural drainage. However, the pneumothorax did not improve, and he was transferred to our hospital for surgery. After the induction of anesthesia, we observed 70% oxygen saturation with one-lung ventilation on the left side. We confirmed that the intubation tube had been placed in the proper position, that no bronchial obstruction had been caused by sputum retention, and that there were no abnormal breathing sounds. Therefore, we considered ventilation-perfusion imbalance to be the cause of desaturation, and continued the operation with additional continuous positive pressure ventilation of the right lung. However, oxygen levels did not improve after the operation. Following a detailed examination, we diagnosed him with pulmonary thromboembolism, since the D-dimer level was elevated and CT showed thrombi in the left main pulmonary artery. We treated the patient with anticoagulation therapy and implanted a temporary inferior vena cava filter. Furthermore, antithrombin III deficiency was suspected following an examination for a potential thrombotic predisposition. This case illustrates the need to consider the risk of pulmonary thromboembolism even in younger patients.</p>

収録刊行物

  • 日本呼吸器外科学会雑誌

    日本呼吸器外科学会雑誌 31(4), 549-553, 2017

    特定非営利活動法人 日本呼吸器外科学会

各種コード

  • NII論文ID(NAID)
    130007433250
  • 本文言語コード
    JPN
  • ISSN
    0919-0945
  • データ提供元
    J-STAGE 
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