Unlüer Erden Erol, Denizbaşi Arzu
Emergency Medicine Department, School of Medicine, Marmara University, Istanbul, Turkey.
Eur J Emerg Med. 2003 Jun;10(2):135-8. doi: 10.1097/01.mej.0000072621.17469.c4.
The clinical manifestations of pulmonary thromboembolism are non-specific, which makes this condition difficult to diagnose. A case of helical computerized tomography angiographically documented pulmonary thromboembolism, which initially presented as upper abdominal and flank pain, is described.
A 46-year-old woman was referred to the emergency department for left flank and upper abdominal pain with diaphoresis and nausea. Her history included rheumatoid arthritis 3 years previously. During her examination the only abnormal finding was abdominal tenderness at the right upper quadrant and a positive Murphy sign without other systemic signs. A chest radiograph demonstrated an atelectatic line at the left lung base. The alveolar-arterial gradient was increased, and a ventilation-perfusion scan revealed a mismatch at the left upper and lower lobes, indicative of pulmonary thromboembolism. Helical computerized tomography angiography revealed filling defects on that side. The patient received anticoagulant therapy and gradually improved.
The pathogenesis of the pain in the flank and upper abdomen is not known in this case. Unexplained upper abdomen and flank pain in a patient with risk factors for pulmonary thromboembolism, such as rheumatoid arthritis, should be investigated to rule out this treatable but potentially fatal condition.
肺血栓栓塞症的临床表现缺乏特异性，这使得该疾病难以诊断。本文描述了一例经螺旋计算机断层血管造影证实的肺血栓栓塞症病例，该病例最初表现为上腹部和侧腹疼痛。
一名46岁女性因左侧侧腹和上腹部疼痛伴出汗及恶心被转诊至急诊科。她有3年前患类风湿关节炎的病史。在检查过程中，唯一的异常发现是右上腹压痛和墨菲氏征阳性，无其他全身症状。胸部X线片显示左肺底部有一条肺不张线。肺泡-动脉氧分压差增大，通气-灌注扫描显示左上叶和下叶不匹配，提示肺血栓栓塞症。螺旋计算机断层血管造影显示该侧有充盈缺损。患者接受抗凝治疗后逐渐好转。
该病例中侧腹和上腹部疼痛的发病机制尚不清楚。对于有肺血栓栓塞症危险因素（如类风湿关节炎）的患者，不明原因的上腹部和侧腹疼痛应进行检查，以排除这种可治疗但可能致命的疾病。
