Dela Cruz Maricel, Devey Jeremy Seelinger
Aria Health Philadelphia, Philadelphia 19124, PA, USA.
Gallup Indian Medical Center, Gallup 87301, NM, USA.
Int J Emerg Med. 2014 Sep 30;7:32. doi: 10.1186/s12245-014-0032-5. eCollection 2014.
Pulmonary hypertension is a disease with many etiologies and is responsible for 200,000 admissions and 25,000 hospitalizations in the United States each year. We report the case of a previously healthy 58-year-old woman who presented to the emergency department with a months-long history of worsening dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea. Despite the severity of her symptoms, she had no corroborative physical exam findings, including jugular venous distension or peripheral edema. Bedside emergency department ultrasonography revealed a dilated right ventricle and bowing of the intraventricular septum into the left ventricle, consistent with pulmonary hypertension. CT angiography of the chest performed in the emergency department revealed a large left atrial mass, found on pathology to be a left atrial sarcoma. This case illustrates how severely symptomatic pulmonary hypertension can have few to no physical exam findings and the utility of bedside emergency department ultrasound in making the presumptive diagnosis.
肺动脉高压是一种病因多样的疾病，在美国每年导致20万例入院治疗和2.5万例住院治疗。我们报告了一例此前健康的58岁女性病例，她因进行性加重的劳力性呼吸困难、端坐呼吸和阵发性夜间呼吸困难长达数月而就诊于急诊科。尽管她症状严重，但体格检查未发现支持性体征，包括颈静脉怒张或外周水肿。急诊科床边超声检查显示右心室扩张，室间隔向左心室膨出，符合肺动脉高压表现。在急诊科进行的胸部CT血管造影显示左心房有一个大肿块，病理检查发现是左心房肉瘤。该病例说明了症状严重的肺动脉高压在体格检查中可能几乎没有或完全没有体征，以及急诊科床边超声在做出初步诊断方面的作用。
