A 20-year-old man with arrhythmogenic right ventricular cardiomyopathy (ARVC) was resuscitated from ventricular fibrillation. He was transferred to our hospital because of progressive multiorgan dysfunction despite mechanical circulatory support with peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) and intra-aortic balloon pump (IABP). At admission to our hospital, chest X-ray showed bilateral complete lung opacification, and echocardiography revealed a massive thrombus occupying the left atrium (LA) and left ventricle (LV). Conversion to central ECMO with transapical LV venting and thrombectomy were performed. The huge LA thrombus occluded all pulmonary veins (PVs). Despite the surgery and intensive care, complete lung opacity remained, and he died of multiorgan failure associated with sepsis. Autopsy demonstrated bilateral pulmonary multiple red infarctions, and histopathology showed alveolar wall necrosis with extensive hemorrhage, confirming a diagnosis of pulmonary hemorrhagic infarction. Extensive pulmonary infarction was attributable to PV occlusion due to massive LA thrombus. PV thrombosis should be considered when refractory lung opacities are encountered during VA-ECMO and necessitates early intervention.

一名患有致心律失常性右心室心肌病 (ARVC) 的 20 岁男性因心室颤动复苏。尽管采用外周静脉动脉体外膜肺氧合 (VA-ECMO) 和主动脉内球囊泵 (IABP) 进行机械循环支持，但他仍因进行性多器官功能障碍转入我院。入院时胸部 X 线检查显示双侧肺完全混浊，超声心动图显示巨大血栓占据左心房 (LA) 和左心室 (LV)。进行了经心尖 LV 通气和血栓切除术转换为中央 ECMO。巨大的 LA 血栓阻塞了所有肺静脉 (PV)。尽管进行了手术和重症监护，但肺部仍然完全混浊，他死于与败血症相关的多器官衰竭。尸检显示双肺多发红色梗死，组织病理学显示肺泡壁坏死伴大面积出血，确诊为肺出血性梗死。大面积肺梗死是由于大量 LA 血栓导致 PV 闭塞。当 VA-ECMO 期间遇到难治性肺混浊并需要早期干预时，应考虑 PV 血栓形成。