A case of pulmonary thromboembolism occurring just after discharge following lobectomy for lung cancer

症例は76歳男性．原発性肺癌に対して，胸腔鏡下左上葉切除術を施行された．周術期に肺塞栓症予防対策を施行し，術後回復良好，16日目に退院した．同日に呼吸苦が出現したが我慢した．20日目に受診し，脱水症状や血液検査で軽度の炎症所見が存在した．しかし，補液などの対症的な治療によってすぐに呼吸困難を含めた全身状態の改善を認めた．原因究明のための精査をすすめたところ，術後26日目の胸部造影CT，下肢血管エコーにて肺塞栓症と深部静脈血栓症の確定診断が得られた．抗凝固治療とIVCフィルター留置を行った．3週間後に，肺血管内血栓は消失したが，下肢血栓の改善を認めず，IVCフィルター留置のまま退院となった．本症例においては，肺血栓塞栓症の診断に，はからずも入院後約1週間を要した．呼吸器外科術後に，呼吸苦などの非特異的な臨床所見を呈した場合，常に肺塞栓症を念頭に置き，より積極的に精査を行う必要があると考える．

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