Brune J, Perol M, Mornex J F
Service de pneumologie, hôpital cardiovasculaire et pneumologique Louis-Pradel, Lyon.
Rev Prat. 1991 Jun 11;41(17):1554-9.
Thromboembolic pulmonary hypertension can occur in two different settings: either acute pulmonary embolism or chronic pulmonary thromboembolism. During acute pulmonary embolism, when the heart and lungs are normal, the mean pulmonary artery pressure never excesses 40 mmHg, this is the maximum pressure the right ventricle can stand. During chronic thromboembolism, the right ventricle can adapt to slowly increasing pulmonary artery pressure. The mean pulmonary artery pressure is usually very elevated and right heart failure is delayed. Diagnosis is difficult when an history of acute pulmonary embolism or phlebitis is lacking. At the beginning, the main differential is psychogenic dyspnea. A clue to the diagnosis is given by the pulmonary function test mainly arterial blood gases at rest and exercise and radionuclide perfusion scan. When the pulmonary hypertension is patent the main differential is primary pulmonary hypertension. No definitive clear cut can be made between multiple distal chronic thromboembolism and primary pulmonary hypertension.
急性肺栓塞或慢性肺血栓栓塞。在急性肺栓塞期间，当心脏和肺部正常时，平均肺动脉压绝不会超过40 mmHg，这是右心室能够承受的最大压力。在慢性血栓栓塞期间，右心室能够适应逐渐升高的肺动脉压。平均肺动脉压通常会显著升高，且右心衰竭会延迟出现。当缺乏急性肺栓塞或静脉炎病史时，诊断较为困难。起初，主要鉴别诊断是心因性呼吸困难。肺功能检查（主要是静息和运动时的动脉血气分析以及放射性核素灌注扫描）可为诊断提供线索。当存在肺动脉高压时，主要鉴别诊断是原发性肺动脉高压。在多发性远端慢性血栓栓塞和原发性肺动脉高压之间无法做出明确的区分。
