PDF(Pubmed)
Abstract：
BACKGROUND: Pulmonary embolism (PE) is a common cause of cardiovascular death whose major acquired risk factors include postoperative states, pregnancy, malignancy, and age. We report a case of PE that occurred after diagnostic curettage for abnormal uterine bleeding, with a medical history of adenomyosis and hysteromyoma.
METHODS: A 31-year-old Han Chinese female was referred to our hospital with menstrual disorders, increased menstrual flow, and severe anemia. After admission, the patient was treated with a blood transfusion, iron supplementation, and erythropoietin, and diagnostic curettage was performed the following day. On the first postoperative day, the patient developed pulmonary embolism with dyspnea and fever diagnosed by CT pulmonary angiography and significantly elevated D-dimer.
RESULTS: Molecular weight heparin was administered for PE for 2 weeks, dyspnea was relieved significantly after 2 days of treatment and the uterine bleeding did not increase; and gonadotropin-releasing hormone agonists were administered for adenomyosis after 1 week of anticoagulant therapy to reduce bleeding. We followed up for 6 months, and the patient had no recurrence of thrombosis and uterine bleeding had improved.
CONCLUSIONS: We speculate that the occurrence of pulmonary embolism was closely related to adenomyosis, hysteromyoma, and curettage in this patient. Treating the presence of both menstrual bleeding and thromboembolism is challenging, and careful management is necessary to avoid therapeutic contradictions.
METHODS: A 31-year-old Han Chinese female was referred to our hospital with menstrual disorders, increased menstrual flow, and severe anemia. After admission, the patient was treated with a blood transfusion, iron supplementation, and erythropoietin, and diagnostic curettage was performed the following day. On the first postoperative day, the patient developed pulmonary embolism with dyspnea and fever diagnosed by CT pulmonary angiography and significantly elevated D-dimer.
RESULTS: Molecular weight heparin was administered for PE for 2 weeks, dyspnea was relieved significantly after 2 days of treatment and the uterine bleeding did not increase; and gonadotropin-releasing hormone agonists were administered for adenomyosis after 1 week of anticoagulant therapy to reduce bleeding. We followed up for 6 months, and the patient had no recurrence of thrombosis and uterine bleeding had improved.
CONCLUSIONS: We speculate that the occurrence of pulmonary embolism was closely related to adenomyosis, hysteromyoma, and curettage in this patient. Treating the presence of both menstrual bleeding and thromboembolism is challenging, and careful management is necessary to avoid therapeutic contradictions.
摘要：
背景：肺栓塞（PE）是心血管死亡的常见原因，其主要获得性危险因素包括术后状态，怀孕,恶性肿瘤，和年龄。我们报告了一例诊断性刮宫后发生的异常子宫出血的PE，有子宫腺肌病和子宫肌瘤病史。
方法：一名31岁的汉族女性因月经失调被转诊到我院，月经量增加，和严重的贫血。入院后,病人接受了输血治疗，补铁,和促红细胞生成素,第二天进行诊断性刮宫。术后第一天,患者出现肺栓塞,经CT肺动脉造影诊断为呼吸困难和发热,D-二聚体显著升高.
结果：分子量肝素用于PE2周，治疗2天后,呼吸困难显著缓解,子宫出血未增加;为减少出血,在抗凝治疗1周后,对子宫腺肌病患者给予促性腺激素释放激素激动剂.我们跟踪了6个月,患者无血栓复发，子宫出血好转。
结论：我们推测肺栓塞的发生与子宫腺肌病密切相关。子宫肌瘤,还有这个病人的刮宫.治疗月经出血和血栓栓塞的存在是具有挑战性的，精心管理是避免治疗矛盾的必要条件。
方法：一名31岁的汉族女性因月经失调被转诊到我院，月经量增加，和严重的贫血。入院后,病人接受了输血治疗，补铁,和促红细胞生成素,第二天进行诊断性刮宫。术后第一天,患者出现肺栓塞,经CT肺动脉造影诊断为呼吸困难和发热,D-二聚体显著升高.
结果：分子量肝素用于PE2周，治疗2天后,呼吸困难显著缓解,子宫出血未增加;为减少出血,在抗凝治疗1周后,对子宫腺肌病患者给予促性腺激素释放激素激动剂.我们跟踪了6个月,患者无血栓复发，子宫出血好转。
结论：我们推测肺栓塞的发生与子宫腺肌病密切相关。子宫肌瘤,还有这个病人的刮宫.治疗月经出血和血栓栓塞的存在是具有挑战性的，精心管理是避免治疗矛盾的必要条件。
