对肺栓塞的新见解与负的D-二次体结果
1Acute medicine, Northampton General Hospital NHS Trust, Northampton, UK hasan.alsararatee@nhs.net.
BMJ case reports
|March 5, 2025
概括
一名中年男性患有持续的胸痛和呼吸短促,尽管初始检测正常,但被诊断患有肺栓塞 (PE). 这一案例强调了先进成像对于在没有风险因素的非典型呈现中诊断PE的重要性.
科学领域:
- 心脏病学 心脏病学
- 肺部医学 肺部医学
- 诊断成像 诊断成像 诊断成像
背景情况:
- 持续的运动性呼吸不良和胸部多发性疼痛可能会带来诊断挑战.
- 初步调查,包括D-二次体测试和胸部X射线,在一些肺栓塞 (PE) 病例中可能是正常的.
- 非典型的PE表现往往缺乏静脉血栓栓塞 (VTE) 的传统风险因素.
研究的目的:
- 为了突出诊断困难在确定PE在患者长期症状和低VTE风险的患者.
- 在没有典型风险因素的情况下,通过CT肺血管图像 (CTPA) 诊断出PE病例.
- 强调在非典型PE病例中临床尽职调查和先进成像学的作用.
主要方法:
- 一个病例报告,一名患者出现了不明原因的运动性呼吸不良和胸痛.
- 使用序列热素,心电图,D-二次测试和胸部X射线,所有结果均为正常.
- 进行CT肺血管图像 (CTPA) 检查持续症状,发现左主肺动脉血栓.
主要成果:
- CTPA发现左主肺动脉血栓,证实了PE.
- 患者没有证据表明右心室张力.
- 里瓦罗克萨班治疗在6个月的随访后导致完全康复.
结论:
- 肺栓塞可能发生在没有可识别的风险因素的患者中,挑战典型的诊断途径.
- 正常的初步调查并不排除PE,需要临床怀疑和先进的成像.
- 这一案例强调了CTPA在诊断PE非典型表现和负面初始处理时的重要性.
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