昏迷是坐肺栓塞的唯一表现,发生在血液动力学稳定的患者身上
1Emergency Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, USA.
Cureus
|March 3, 2026
概括
肺栓塞 (PE) 可以表现为突然昏迷而没有典型症状. 这一案例凸显了在患有孤立昏迷的患者中考虑PE的重要性,即使有微妙的临床和实验室发现.
科学领域:
- 紧急医疗 紧急医疗
- 心脏病学 心脏病学
- 肺部病理学 肺部病理学
背景情况:
- 昏迷是急诊室常见的抱怨,有不同的病因.
- 肺栓塞 (PE) 經典呈現呼吸困難和胸痛,但不典型的呈現也會發生.
- 作为PE的唯一症状,孤立的昏迷是不常见的,但有可能发生.
研究的目的:
- 报告急性坐肺栓塞病例,仅表现为昏迷.
- 为了强调PE在没有典型的迹象和症状的情况下的诊断挑战.
- 突出在诊断PE时微妙的临床和实验室线索的实用性.
主要方法:
- 一个77岁的男性出现昏迷的病例报告.
- 临床评估包括体检,实验室测试 (热波宁,BNP),心电图和胸部X射线.
- 通过CT肺血管造影确认诊断.
- 治疗包括抗凝药和导管导向的血栓切除术.
主要成果:
- 患者出现了孤立的昏迷,血液动力学稳定性和额头磨损.
- 实验室发现包括血小板缺血,高位素,和高BNP.
- 电脑心电图显示了新的右心应变;胸部X射线正常.
- CTPA证实了急性坐PE,由于随后的血液动力学不稳定性,需要进行血栓切除术.
结论:
- 肺栓塞可以呈现为孤立的昏迷,具有挑战性的初步诊断.
- 微妙的临床症状和实验室异常 (例如,升的热素,BNP,心脏右侧紧张) 是重要的诊断线索.
- 及时识别和干预对于管理异常呈现的PE至关重要.
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