療，予防に関するガイドライン
（2017 年改訂版）
１．
Anja Boc, Nina Vene, Monika Stalc, et al. :
Unprovoked proximal venous thrombosis is associated
with an increased risk of asymptomatic pulmonary
８．
佐久間聖仁：急性肺血栓塞栓症の診断：今後の方向
性．Ther Res 30：744-747，2009
９． 大濱佐知，山田宏，速水元，他：急性大動脈解離術後
embolism. Tromb Res 133（6）:1011-1016, 2014
２．
Fenghe Li, Xuehu Wang, Wen Huang, et al. : Risk
－30－
に肺塞栓を併発し，経皮的人工心肺補助装置を導入し救
命しえた１例．ICUとCCU 32
（11）
: 1051-1057，2008
Yamagata Med J（ISSN 0288-030X）2022；40
肺血栓塞栓症ハイリスク症例に対するスクリーニングCT
（1）
：27-31
DOI 10.15022/00005302
A case reaffirming the importance of screening CT
before ambulation in patients with high risk of
pulmonary thromboembolism
Soekawa Kiyotaka， Kuroki Masahiro， Narisawa Ayuka，
Kurota Misato， Kawamae Kaneyuki
Department of Anesthesiology, Yamagata University Hospital
ABSTRACT
Introduction: We encountered a case of asymptomatic pulmonary thromboembolism（PTE）
, which
was diagnosed by screening CT before ambulation.
Clinical course: The patient is a 40-year-old woman with a height of 166 cm and weight of 124 kg
（body mass index, 44.9 kg/m２）
. She visited our emergency department due to fever and dyspnea
and was diagnosed with pneumonia by CT. Due to respiratory failure, she was intubated and admitted
to our intensive care unit, where continuous administration of heparin was initiated to prevent
thrombosis. Although the patient did not have symptoms suggesting PTE, she was considered highrisk for thrombosis; as such, she underwent CT prior to ambulation. CT scan showed extensive
thrombi in both pulmonary arteries. Subsequently, her platelet count decreased which was suspected
to have been heparin-induced thrombocytopenia. Ambulation was postponed, anticoagulant was
changed, and the patient was transferred to the general ward with no worsening of symptoms.
Discussion: Although asymptomatic, this case was diagnosed with PTE based on the assessment of
several points such as risk factors for thrombosis, pre-test probability, elevated D-dimer, etc.
Conclusion: Asymptomatic PTE may develop in patients with a high risk of thrombosis; therefore, a
thorough assessment of thrombosis before ambulation is necessary.
Keywords: pulmonary thromboembolism（PTE）,screening, CT, D-dimer, heparin-induced
thrombocytopenia（HIT）
－31－
...
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