抄録
The current study was done to clarify the recent trend of clinical pulmonary thromboembolism (PTE) in Japan. The time has long passed since thromboembolic diseases of the lung were rare in our country. We have experienced, however, tweny-four clinically manifested patients with PTE during the past two years. Although a number of symptoms and findings have been reported to facilitate the diagnosis, they were for the most part nonspecific and therefore nondiagnostic. Combined perfusion and ventilation scans showing a perfusion defect with normal ventilation were reported to be useful for diagnosis of PTE, but a special attention should be paid to the fact that a massive perfusion defect was accompanied by decreased ventilation of the affected lung. From a pathophysiologic study, an exertional dyspnea associated with increased A-a DO2 and also increased a-ET DCO2 in patients without apparent pulmonary consolidation on their chest roentgenogram was strongly suggestive of PTE. A-a DO2 and a-ET DCO2 were shown to be variables independent to each other. a-ET DCO2 was valuable for clinical diagnosis with direct evidence of high VA/Q units resulting from occluded pulmonary arteries. On the other hand, A-a DO2 which was once elevated in the acute stage of PTE was decreased according to the recovery with a close liner correlation to the actual perfusion defect and was a sensitive indicator suggestive of resolved emboli. A-a DO2 was considered to provide measures of the active severity of PTE unlike a-ET DCO2.
