A Surgical Case of Acute Pulmonary Thromboembolism with Multiple Mononeuritis

(The Second Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan)

Tsuneo Nakajima Hirofumi Nakano Kuniyoshi Watanabe
Tamaki Takano Ryo Hasegawa Hirohisa Goto
Hiroto Kitahara Hideo Kuroda Jun Amano
The patient was a 63-year-old man with a history of multiple mononeuritis with hypergammaglobulinemia since 1980. The symptoms gradually worsened, and he had been bed-ridden since 1992. On February 28, 1997, he had sudden dyspnea after defecation. Echocardiography demonstrated a large thrombus in the right atrium and the right ventricle. Enhanced chest computed tomography revealed thrombi in the bilateral pulmonary arteries. The patient was considered to have acute pulmonary thromboembolism, and an emergency operation was indicated. Thrombectomy was performed under extracorporeal circulation through a median sternotomy. No thrombi were found in the right atrium or the right ventricle, and thrombi in the bilateral pulmonary arteries were removed completely. Four days after the operation, a Greenfield filter was implanted in the vena cava inferior because venography detected a thrombus in the right common iliac vein. The postoperative course was uneventful. No pulmonary rethromboembolisms were noticed after the operation. The long duration of being bed-ridden seemed to be the chief cause of thrombosis in the deep veins, and hyperviscosity due to hypergammaglobulinemia may have caused hyperthrombogenicity.
@Jpn. J. Cardiovasc. Surg. 30: 314-316(2001)