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49-jährige Patientin mit tiefer Beinvenenthrombose, Lungenembolie und linksseitiger Hemiparese

A 49-year-old woman with deep vein thrombosis, pulmonary embolism, and left-sided paralysis

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Zusammenfassung

Wir berichten in der vorliegenden Kasuistik über eine 49-jährige Patientin, die aufgrund einer neu aufgetretenen linksseitigen Hemiparese stationär eingewiesen wurde, als deren Ursache ein embolischer Verschluss der rechten A. cerebri media nachzuweisen war. Bei bestehender 2-Etagen-Beinvenenthrombose und rechtsventrikulärer Druckerhöhung im Rahmen einer hämodynamisch relevanten Lungenembolie mit zusätzlichem Vorliegen eines persistierenden Foramen ovale (PFO) war von einer paradoxen Embolie auszugehen. Da nach dem Versuch einer lokalen Lyse des thrombembolischen Verschlusses der A. cerebri media rechts eine geringe lokale Einblutung im Bereich der Basalganglien rechts hinzutrat, war eine systemische Lyseapplikation zur Therapie der Lungenembolie kontraindiziert. Deshalb wurde im Akutstadium ein katheterinterventioneller PFO-Verschluss mittels Doppelschirmprothese durchgeführt. Die Lungenembolie ließ sich nach Einlage eines Pigtail-Katheters in die rechte A. pulmonalis durch lokoregionäre Fibrinolyse effektiv therapieren.

Abstract

We report the case of a 49-year-old female patient who was admitted stationary because of a left-sided paralysis which had appeared some hours before. An embolic occlusion of the right A. cerebri media turned out to be the cause. A paradoxical embolism could be assumed because of an existing deep vein thrombosis and an increased right-ventricular pressure within a hemodynamically relevant fulminant pulmonary embolism as well as the additional existence of a patent foramen ovale (PFO). Systemic lysis as treatment of the pulmonary embolism was contraindicated because slight bleeding had occurred in the area of the right basal ganglia after treatment of the embolic occlusion of the right A. cerebri media by a local lysis. Subsequently and in the acuteness, a catheter interventional PFO-closure via a double-umbrella device was placed and the pulmonary embolism was effectively treated by a local lysis through the insertion of a pigtail-catheter into the right pulmonary artery.

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Authors and Affiliations

  1. Einheit für multidisziplinäre Intensivmedizin, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland

    D. Jurisch, D. Szokodi & L. Engelmann

  2. Medizinische Klinik und Poliklinik I, Universitätsklinikum Leipzig, Kardiologie und Angiologie, Leipzig, Deutschland

    D. Pfeiffer

  3. Klinik und Poliklinik für diagnostische und interventionelle Radiologie, Universitätsklinikum Leipzig, Leipzig, Deutschland

    T. Kahn

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  1. D. Jurisch
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  2. D. Szokodi
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  4. T. Kahn
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  5. L. Engelmann
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Correspondence to D. Jurisch.

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Jurisch, D., Szokodi, D., Pfeiffer, D. et al. 49-jährige Patientin mit tiefer Beinvenenthrombose, Lungenembolie und linksseitiger Hemiparese. Internist 49, 1251–1258 (2008). https://doi.org/10.1007/s00108-008-2139-3

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  • DOI: https://doi.org/10.1007/s00108-008-2139-3

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