頸髄損傷7年後に発症した若年性肺塞栓の1例

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The patient, a 25-year-old woman, was admitted to our hospital for compre-hensive rehabilitation 7 years after traumatic spinal cord injury. On the 7th day after admission she lost consciousness. The physical examination revealed tachycardia, tachyp-nea and a pan-systolic murmur on the left sternal border between the 4th and 5th rib. The white blood cell count was 11,310/μ1 and serum LDH was 5,26 IU/l. Arterial blood gases revealed 39 mmHg. Chest X-ray revealed moderate cardiomegaly without evidence of pulmonary congestion. Ultrasonography showed marked right hypertrophy. Doppler flow study showed that systolic pulmonary artery pressure was 50 mmHg. Swan-Ganz catheter-ization showed that pulmonary artery pressure was 45/22 (mean 31) mmHg. Thus, based on three findings the diagnosis of pulmonary embolism was established. We treated her with intravenous heparin. On the 3rd day from onset, she recovered her consciousness and pulmonary artery pressure normalized. Three weeks after the, onset, ^<99m>Tc-pulmonary perfusion scan showed a perfusion defect over S^9 of the right lobe. To the best of our knowledge, there has been no report of a patient developing pulmonary infarction after such a long time after spinal cord injury. (Jpn J Rehabil Med 2001 ; 38 : 219-222)
社団法人日本リハビリテーション医学会の論文
2001-03-18