Topan Rabia, Hyde Tom
Department of Medicine, Great Western Hospital, Swindon, UK.
BMJ Case Rep. 2012 Aug 24;2012:bcr2012006716. doi: 10.1136/bcr-2012-006716.
A 34-year-old dental nurse presented with a 2-day history of retrosternal chest pain that was constant and 'burning' in nature. She was otherwise fit and well, no significant prior medical history and no ischaemic heart disease risk factors. Clinical examination was entirely normal apart from pyrexia of 38.3°C. Admission ECG showed ST depression in the inferior and anterolateral leads suggestive of myocardial ischaemia, consequently a CT coronary angiogram (CTCA) was performed. This showed normal coronary arteries, incidental distal oesophageal thickening was seen. Further history taking revealed that her youngest daughter had recently suffered from cold sores. The patient went on to have a diagnostic procedure, an oesophagogastroduodenoscopy. Biopsies confirmed acute oesophagitis with features suggestive of herpes virus infection. The patient responded promptly to oral acyclovir. This case highlights the value of CT coronary angiogram in identifying non-cardiac pathology in patients with a low pretest probability of coronary artery disease.
一名34岁的牙科护士主诉胸骨后胸痛2天，疼痛持续且呈“烧灼样”。她身体其他方面健康，无重大既往病史，也没有缺血性心脏病风险因素。除体温38.3°C发热外，临床检查完全正常。入院心电图显示下壁和前侧壁导联ST段压低，提示心肌缺血，因此进行了CT冠状动脉造影（CTCA）。结果显示冠状动脉正常，偶然发现食管远端增厚。进一步询问病史发现，她最小的女儿最近患了唇疱疹。患者接着接受了一项诊断性检查——食管胃十二指肠镜检查。活检证实为急性食管炎，具有提示疱疹病毒感染的特征。患者口服阿昔洛韦后迅速康复。该病例凸显了CT冠状动脉造影在识别冠状动脉疾病预检概率较低患者的非心脏病变方面的价值。
