Sato Shun, Sugiura Toshihiko, Tanabe Nobuhiro, Terada Jiro, Sakao Seiichiro, Kasahara Yasunori, Takiguchi Yuichi, Tatsumi Koichiro
School of Medicine, Chiba University.
Nihon Kokyuki Gakkai Zasshi. 2010 Nov;48(11):836-41.
We report a case of a 70-year-old man with chronic thromboembolic pulmonary hypertension (CTEPH) in whom bronchial asthma had been clinically diagnosed and treated, and who showed remarkable improvement by pulmonary endarterectomy. He had dyspnea on exertion and had been clinically treated for bronchial asthma for 15 years. However, his symptoms did not improve after oral and inhaled corticosteroid therapy, and he had dyspnea at rest. CTEPH was suspected by echocardiography and computed tomography (CT) and he was admitted to our hospital. Perfusion scans showed multiple segmental perfusion defects with normal ventilation study, and contrast-enhanced CT showed intramural thrombi in both pulmonary arteries. Right cardiac catheterization revealed a mean pulmonary arterial pressure of 70 mm Hg and pulmonary vascular resistance of 1699 dyn.s.cm(-5) with chronic thromboembolic findings on pulmonary angiography. After surgery his pulmonary hemodynamics and symptoms significantly improved. CTEPH is rarely diagnosed at the initial visit because the only symptom is dyspnea on exertion, and it is often misdiagnosed as other respiratory diseases. But it is important to suspect and diagnose CTEPH in patients with unexplained dyspnea because this disease can be cured by surgery.
我们报告一例70岁男性慢性血栓栓塞性肺动脉高压（CTEPH）患者，该患者临床上曾被诊断为支气管哮喘并接受治疗，经肺动脉内膜剥脱术后症状显著改善。他有劳力性呼吸困难，临床上诊断为支气管哮喘并接受治疗达15年。然而，口服及吸入糖皮质激素治疗后症状未改善，且出现静息时呼吸困难。经超声心动图和计算机断层扫描（CT）怀疑为CTEPH，遂收入我院。灌注扫描显示多个节段性灌注缺损，通气研究正常，增强CT显示双侧肺动脉壁内血栓。右心导管检查显示平均肺动脉压为70 mmHg，肺血管阻力为1699 dyn.s.cm(-5)，肺血管造影有慢性血栓栓塞表现。术后其肺血流动力学和症状明显改善。CTEPH在初诊时很少被诊断出来，因为唯一症状是劳力性呼吸困难，且常被误诊为其他呼吸系统疾病。但对于不明原因呼吸困难的患者，怀疑并诊断CTEPH很重要，因为该病可通过手术治愈。
