<症例>僧帽弁狭窄症に合併した慢性多発性肺塞栓症の一例

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A 41-year-old man was admitted for the treatment of heart failure with rheumatic valvular heart disease. On admission physical examination revealed high fever (38.8℃), moist rales on the both lung fields and signs of mitral stenosis and tricuspid insufficiency. Laboratory data revealed leukocytosis (10,900/mm^3), elevated ESR (50mm/h), positive CRP (5+), mild liver dysfunction and respiratory alkalosis on blood gas analysis. An electrocardiogram showed complete RBBB and right ventricular hypertrophy. A chest roentgenogram revealed an infiltrate in the lower lobe of the right lung and right-sided pleural effusion. ^<99m>Tc perfusion lung scan revealed diminished uptake over the both lower lungs. The Swan-Ganz catheterization was performed 1 week before death, and revealed low cardiac output of 2.92L/min and pulmonary hypertension (PA pressure 60/34mmHg with a mean of 44mmHg). He was diagnosed as bronchopneumomia and rheumatic mitral stenosis with congestive heart failure, and was treated with antibiotics, diuretics, digitalis and dopamine. Serial chest roentgenograms revealed clearing of the right-sided infiltrate and pleural effusion, but in spite of the treatment, heart failure was progressively aggravated and new infiltrates appeared again on the left lung field. Death occurred three months after admission. At autopsy the right lung weighed 740gm, and left lung 1010gm. In the left lower pulmonary artery, there was a large adherent old organizing thromboembolus. Hemorrhagic infarction was present in the left lower lobe. The right lower pulmonary artery consisted of thromboemboli with hemorrhagic infarction. There was tight mitral stenosis with fibrosis and calcification of the anterior and the posterior mitral valve, and mild deformity of the aortic valve was also found. No thrombi were found in the right atrium and ventricle.
近畿大学の論文
1981-06-25

<症例>僧帽弁狭窄症に合併した慢性多発性肺塞栓症の一例

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