双侧肺动脉栓塞合并蛇形右心房血栓经口服抗凝成功治疗：一例病例报告
Co-occurrence of Bilateral Pulmonary Artery Embolism and a Serpentine Right Atrial Thrombus Successfully Managed With Oral Anticoagulation: A Case Report.
摘要(中文译文)
蛇形血栓，也称为蛇样或蠕虫样漂浮血栓，是一种罕见但危及生命的心内疾病，属于真正的治疗急症。若不治疗，预后极差。该病的危险性尤其在于血栓碎裂和移位的风险，可导致肺动脉主干完全阻塞。我们报告一例80岁血流动力学稳定的男性患者，表现为进行性呼吸困难和严重低氧血症。计算机断层扫描肺动脉造影证实双侧近端肺栓塞，经胸超声心动图（TTE）发现右心房内蛇形自由漂浮血栓，舒张期脱入右心室。记录到显著的右心室功能障碍和重度肺动脉高压（估测肺动脉压67 mmHg）。风险分层得出肺栓塞严重程度指数（PESI）评分为110分（IV级，高危），静脉血栓栓塞出血（VTE-BLEED）评分为3分（高出血风险）。鉴于血流动力学稳定且出血风险升高，暂缓全身溶栓治疗。患者最初接受静脉普通肝素治疗五天，随后改为口服阿哌沙班抗凝（10 mg每日两次，共七天，之后5 mg每日两次）。第15天经胸超声心动图证实心内血栓完全消退，同时临床和呼吸状况改善。本病例为支持口服抗凝作为经仔细筛选、血流动力学稳定、高出血风险的蛇形右心房血栓患者当更积极策略存在禁忌或不可行时的一种可行治疗选择的稀少文献增添了证据。它强调了个体化决策和长期监测的重要性。
Abstract
Serpentine thrombus, also referred to as a snake-like or worm-like floating thrombus, is a rare but life-threatening intracardiac condition representing a true therapeutic emergency. Without treatment, the prognosis is extremely poor. The condition is particularly dangerous due to the risk of thrombus fragmentation and migration, which can lead to complete obstruction of the pulmonary trunk. We report the case of an 80-year-old hemodynamically stable man who presented with progressive dyspnea and severe hypoxemia. Computed tomography pulmonary angiography confirmed bilateral proximal pulmonary embolism, and transthoracic echocardiography (TTE) identified a serpiginous free-floating thrombus in the right atrium, prolapsing into the right ventricle during diastole. Significant right ventricular dysfunction and severe pulmonary hypertension (estimated pulmonary artery pressure 67 mmHg) were documented. Risk stratification yielded a Pulmonary Embolism Severity Index (PESI) score of 110 (Class IV, high risk) and a Venous Thromboembolism Bleeding (VTE-BLEED) score of 3 (high bleeding risk). Given hemodynamic stability and elevated bleeding risk, systemic thrombolysis was deferred. The patient was initially managed with intravenous unfractionated heparin for five days, followed by oral anticoagulation with apixaban (10 mg twice daily for seven days, then 5 mg twice daily). Complete resolution of the intracardiac thrombus was confirmed on TTE on day 15, with concurrent clinical and respiratory improvement. This case adds to the sparse literature supporting oral anticoagulation as a viable therapeutic option in carefully selected, hemodynamically stable patients with serpentine right atrial thrombus and high bleeding risk, when more aggressive strategies are contraindicated or unavailable. It underscores the importance of individualized decision-making and long-term surveillance.
如何引用
AMA
Khalid Zrigui, Illy Azday, Zayna Nadhil, Zineb Mehssani, Nadia Fellat. Co-occurrence of Bilateral Pulmonary Artery Embolism and a Serpentine Right Atrial Thrombus Successfully Managed With Oral Anticoagulation: A Case Report.. Cureus. 2026; doi:10.7759/cureus.108513.
APA
Khalid Zrigui, Illy Azday, Zayna Nadhil, Zineb Mehssani, Nadia Fellat (2026). Co-occurrence of Bilateral Pulmonary Artery Embolism and a Serpentine Right Atrial Thrombus Successfully Managed With Oral Anticoagulation: A Case Report.. Cureus. https://doi.org/10.7759/cureus.108513
GB/T 7714
Khalid Zrigui, Illy Azday, Zayna Nadhil, Zineb Mehssani, Nadia Fellat. Co-occurrence of Bilateral Pulmonary Artery Embolism and a Serpentine Right Atrial Thrombus Successfully Managed With Oral Anticoagulation: A Case Report.[J]. Cureus, 2026 doi:10.7759/cureus.108513.
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