뇌경색의 색전 원인 병소로서 상행대동맥의 유동성 혈전 1예
A Case of Mobile Thrombus in Ascending Aorta as an Embolic Source of Stroke
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폐암(소세포암)으로 항암치료 시행 후 외래 추적관찰 중인 환자가 내원 3시간 전 시작된 우하지의 무기력함으로 응급실에 내원하여 뇌 자기공명영상을 통하여 급성 뇌경색을 진단하였다. 뇌 자기공명혈관조영술과 경흉부 심초음파에서 특이 소견이 없었고, 경식도 심초음파를 통하여 대동맥궁 근처의 상행대동맥에 실형태의 유동성 혈전을 가진 1.3 × 0.9 cm 크기의 둥근 종괴를 확인하였다. 스타틴과 함께 항응고 치료를 시행하였고, 20일 후에 재시행한 경식도 심초음파에서 실 형태의 종괴는 보이지 않았으며 둥근 종괴의 크기는 감소하였다. 퇴원 후 항응고 치료를 항혈소판 치료로 변경하였고, 외래 추적 과정에서 재발 소견은 관찰되지 않았다. 흉부 대동맥 경화반이 관찰되는 환자들 중에서 상행대동맥에 위치한 복합죽종은 그 빈도가 매우 드물기에 문헌고찰과 함께 보고하는 바이다.
Abstract
Plaque in the ascending aorta can be an important embolic source of stroke. Diagnostic tests for identifying embolic sources are critical for preventing the occurrence of other devastating complications before the initiation of treatment. Here, we report the case of a patient with mobile thrombi attached to the distal ascending aortic wall that were identified by transesophageal echocardiography (TEE). The mobile thrombi in the ascending aorta were treated with anticoagulants and statins. The TEE images we obtained for this case were noteworthy because complex atheromas of the ascending aorta are very rare. (Korean J Med 2011;80:S152-S156)
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