【摘要】 目的提高对肺栓塞的认识,减少其误诊率。方法回顾性分析36例肺栓塞合并胸腔积液病例。结果94例肺栓塞中合并胸腔积液36例,占38%,其中少量积液30例,中等量积液4例,大量积液2例。双侧积液21例,右侧积液9例,左侧积液6例,心包积液4例。6例中、大量积液胸水检查,均为渗出性,其中4例为血性(2例为肺癌)。36例中D-二聚体升高35例;螺旋CT36例均有肺动脉栓塞改变,其中2例合并肺不张,4例合并心包积液。15例作肺通气灌注扫描均有阳性表现。结论肺栓塞是胸腔积液的常见病因之一,临床遇到不明原因的胸腔积液特别是血性积液,要考虑肺栓塞的可能,及时筛查D-二聚体,阳性者高度怀疑肺栓塞,再行肺通气灌注扫描﹑螺旋CT等检查进一步明确诊断。更多还原

【Abstract】 Objective To improve on the understanding of pulmonary embolism aiming to reduce misdiagnosis rate.Methods Retrospective analysis of 36 cases of pulmonary embolism with pleural effusion for the past 4 years,combine with discussion after relevant literature review.Results 36 out of the 94 cases(38%)of pulmonary embolism had pleural effusion(38%),among which 30 cases were small effusion,4 were moderate effusion and 2 of massive effusion.Bilateral effusion was present in 21 cases,right sided effusion in 9,left sided effusion in 6 and pericardial effusion in 4 cases.Examination of hydrothorax review effusion in 6 moderate and massive effusion patients,4 were haemothorax(2 were associated with lung cancer).35 within 36 cases had an elevated D-dimer level.Spiral CT examination showed embolic changes of pulmonary artery in all 36 patients,with 2 cases of concomitant pulmonary atelectasis,and 4 cases of concomitant pericardial effusion.Pulmonary ventilation and perfusion scan in 15 cases showed positive test events.Conclusion Pulmonary embolism is one of the commonest etiology of pleural effusion;clinically,a possible diagnosis of pulmonary embolism should be taking in account when encountering pleural effusion of unknown origin and particularly when the pleural fluid bloody.In case of a positive timely D-dimer screening,pulmonary embolism should be highly suspected;further pulmonary ventilation and perfusion scan,as well as spiral CT scan should be performed in order to confirm the diagnosis.更多还原