Martin Thomas, Shariq Sohail
Acute Medical Unit, Ealing Hospital, London, UK.
BMJ Case Rep. 2010 Aug 31;2010:2943. doi: 10.1136/bcr.04.2010.2943.
This case illustrates that d-dimer is elevated in patients with acute aortic dissection. A 49-year-old woman presented with central, crushing chest pain exacerbated on inspiration. The chest pain was associated with right-leg numbness and pain, although peripheral pulses and blood pressures were normal. Routine bloods demonstrated an elevated d-dimer with a normal ECG and chest x-ray radiograph. A differential diagnosis of pulmonary embolism and acute aortic dissection was made. CT-angiogram showed type B aortic dissection. This case report highlights the mounting evidence that d-dimer is elevated in practically all incidents of aortic dissection and could be useful as a negative predictive marker.
该病例表明，急性主动脉夹层患者的D-二聚体水平会升高。一名49岁女性因吸气时加重的中央压榨性胸痛前来就诊。胸痛伴有右腿麻木和疼痛，尽管外周脉搏和血压正常。常规血液检查显示D-二聚体升高，心电图和胸部X光片正常。鉴别诊断为肺栓塞和急性主动脉夹层。CT血管造影显示为B型主动脉夹层。本病例报告强调了越来越多的证据表明，几乎在所有主动脉夹层病例中D-二聚体都会升高，并且可用作阴性预测指标。
