폐색전증

• 정의: 폐 동맥의 혈전색전증

• 위험인자: 수술 후 움직임 제한, 암, 임신, 약물, 흡연 등

• 색전 발생 부위: 심부 하지 정맥(m/c), 신장 정맥, 상지 정맥

• 증상: 갑작스런 호흡곤란, 빈맥, 빈호흡 기침, 흉막성 통증, 객혈

• 영상소견

  • CT : Pulmonary artery 내부의 low density clot 확인

    

  • Hampton sign: 혈전색전증으로 인한 폐실질의 wedge-shaped infarction 소견

    

  • Westermark sign: central pulmonary vessel 확장과 focal peripheral hyperlucency

    

• EKG 소견

  • sinus tachycardia

  • new onset atrial arrhthmia

  • new RBBB

  • S1Q3T3: Lead I의 prominent S wave, Lead III의 Q wave + T inversion

  • T wave inversion in V1~V4

  예시)

  

  → S1Q3T3와 함께 V1~V4 T wave inversion이 보이는 소견

  
  

• 폐색전증 진단

  

  
  

[1] Harrison 21e, pg.2091~2098

[2] UpToDate - Epidemiology and pathogenesis of acute pulmonary embolism in adults, Pathogenesis and Pathophysiology - Risk factors, Source

[3] UpToDate - Clinical presentation, evaluation, and diagnosis of the nonpregnant adult with suspected acute pulmonary embolism, D-dimer, Lower-extremity ultrasound with Doppler

[1] Harrison 21e, pg. 2098~2100

[2] UpToDate - Approach to thrombolytic (fibrinolytic) therapy in acute pulmonary embolism: Patient selection and administration, contraindications to thrombolysis