Babak Sam, Sriram Krishna B
Department of Respiratory Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
School of Medicine, Griffith University, Queensland, Australia.
BMJ Case Rep. 2014 Jun 2;2014:bcr2014204172. doi: 10.1136/bcr-2014-204172.
We report the case of a middle-aged man where a diagnosis of pulmonary embolism (PE) was delayed due to initial underestimation of risk and over-reliance on D-dimer testing. The patient presented with pleuritic chest pain after a 5 h domestic flight. The treating clinicians presumed that this duration of immobilisation was insufficient to cause a PE, D-dimer was not measured and the patient was discharged home. One week later, the patient re-presented due to persistence of chest pain. On this occasion, D-dimer was measured and it was normal, which was interpreted as excluding a PE. Subsequently, a CT pulmonary angiogram was performed, which demonstrated a subsegmental PE. This case highlights the importance of accurate assessment of PE-risk factors and following clinical guidelines, since a delayed diagnosis of PE is associated with increased mortality.
我们报告了一例中年男性病例，其肺栓塞（PE）的诊断因最初对风险的低估和对D - 二聚体检测的过度依赖而延迟。患者在进行了5小时的国内航班飞行后出现胸膜炎性胸痛。主治医生推测这种制动时间不足以导致肺栓塞，未检测D - 二聚体，患者被送回家。一周后，患者因胸痛持续而复诊。此次检测了D - 二聚体，结果正常，这被解读为排除了肺栓塞。随后进行了CT肺动脉造影，显示为亚段肺栓塞。该病例凸显了准确评估肺栓塞风险因素并遵循临床指南的重要性，因为肺栓塞的延迟诊断与死亡率增加相关。
