慢性血栓栓塞性肺动脉高压：勿错失早期诊断的机会。
Chronic thromboembolic pulmonary hypertension: do not miss the chance for an early diagnosis.
作者信息
Bagalas Vasilis, Paspala Asimina, Sourla Evdokia, Akritidou Sofia, Tsolakidou Katerina, Boutou Afroditi, Pitsis Antonis A, Manika Katerina, Kioumis Ioannis P, Stanopoulos Ioannis, Pitsiou Georgia
机构信息
Respiratory Intensive Care Unit, Aristotle University of Thessaloniki, G.H. "G. Papanikolaou", Thessaloniki, Greece.
St. Luke's Hospital, Thessaloniki Heart Institute, Thessaloniki, Greece.
出版信息
Am J Case Rep. 2014 Sep 5;15:378-81. doi: 10.12659/AJCR.891014.
BACKGROUND
Chronic thromboembolic pulmonary hypertension most often results from obstruction of the pulmonary vascular bed by nonresolving thromboemboli. Misdiagnosis of the disease is common because patients often present with subtle or nonspecific symptoms. Furthermore, some features in chest imaging may mimic parenchymal lung disease. The most clinically important mimic in high-resolution chest tomography is air trapping, which can be seen in a variety of small airway diseases.
CASE REPORT
We present the case of a 45-year-old woman with a long history of dyspnea and exercise intolerance, misdiagnosed with allergic alveolitis. The diagnosis of CTEPH was finally established with computed tomography (CT) angiography and hemodynamics.
CONCLUSIONS
Chronic thromboembolism is under-diagnosed and also frequently misdiagnosed in clinical practice. The present report aims to increase the awareness of clinicians towards an accurate diagnosis of the disease, which is necessary for the early referral of CTEPH patients for operability.
背景
慢性血栓栓塞性肺动脉高压最常见的病因是未溶解的血栓栓子阻塞肺血管床。该病误诊很常见，因为患者常表现出细微或非特异性症状。此外，胸部影像学的一些特征可能类似实质性肺疾病。高分辨率胸部断层扫描中最具临床意义的类似表现是空气潴留，这在多种小气道疾病中都可见到。
病例报告
我们报告一例45岁女性患者，有长期呼吸困难和运动不耐受病史，曾被误诊为过敏性肺泡炎。最终通过计算机断层扫描（CT）血管造影和血流动力学检查确诊为慢性血栓栓塞性肺动脉高压。
结论
慢性血栓栓塞在临床实践中诊断不足且经常被误诊。本报告旨在提高临床医生对该病准确诊断的认识，这对于慢性血栓栓塞性肺动脉高压患者早期转诊以评估手术可行性是必要的。
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