2018 年 45 巻 4 号 p. 589-592
Pulmonary embolism (PE) is a clinical entity with a high mortality rate and hence requires accurate, urgent diagnosis and emergency therapy. We report a case of successful treatment of PE in a patient with renal cell carcinoma (RCC) with tumor thrombosis of the renal vein and the inferior vena cava (IVC). PE was diagnosed using electrocardiography (ECG), echocardiography, D-dimer level elevation and contrast-enhanced computed tomography. First, ECG showed a new sinus tachycardia and T wave flattening in the inferior leads (II, III, aVf) in contrast to routine ECG performed previously at a medical health check-up. Second, echocardiography revealed a dilated right ventricle, tricuspid regurgitation, and elevation of systolic pulmonary artery pressure. We emergently inserted a temporary IVC filter at the proximal end of the tumor thrombus under serial echocardiographic evaluation, followed by thrombolytic therapy and anticoagulation therapy. After 3 days, we performed radical nephrectomy and thrombectomy of the IVC. After surgery, the temporary IVC filter was removed, and the anticoagulation therapy was continued. The patient remained symptom free 3 years after surgery. For the diagnosis of PE, it is important to compare the previous ECG obtained on routine medical health check-up and the ECG results at diagnosis. In conclusion, during a medical health check-up in clinical practice, despite its rare occurrence, a life-threatening PE should be ruled out in a patient with risk factors, symptoms, and ECG findings such as tachycardia and ST-T change in the inferior leads and patients with such findings should be urgently referred to a cardiovascular specialist.
