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成人左心室憩室和动脉导管未闭误诊为冠状动脉疾病伴梗死性动脉瘤:一例报告

Adult left-ventricular diverticulum and patent ductus arteriosus misdiagnosed as coronary artery disease with infarct aneurysm: a case report.

作者信息

Qu Hong, Liu Tianqi, Wang Haiyan, Wang Dong, Li Quan

机构信息

Department of Cardiovascular Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, 16766 Jingshi Road, Jinan, 250014, China.

出版信息

BMC Cardiovasc Disord. 2015 Nov 14;15:149. doi: 10.1186/s12872-015-0146-6.

Abstract

BACKGROUND

Left-ventricular diverticulum (LD) associated with patent ductus arteriosus (PDA) is extremely rare. We have not found any previous reports of the coexistence of these two malformations. Such an association presenting with chest pain mimicking an infarct aneurysm with angina or a takotsubo cardiomyopathy with chest pain is difficult to differentiate clinically. Here, we discuss several diseases characterized by left-ventricular apical protrusion with chest pain to familiarize clinicians with the differential diagnosis of these diseases.

CASE PRESENTATION

A 58-year-old woman was referred to our hospital because of complaints of chest pain and dyspnoea, mainly on exertion. An electrocardiograph on admission showed a q-wave in lead I, a Q-wave in lead aVL, and an abnormal T-wave in the limb leads and leads V4 to V6. A transthoracic echocardiograph revealed a PDA and a protrusion arising from the apex of the left ventricle. The diagnosis on admission was PDA and coronary artery disease with infarct aneurysm. To evaluate the source of the chest pain, further evaluations were performed. Coronary angiography showed no abnormal findings. Left ventriculography confirmed the presence of an apical contractile out-pouching. Based on these findings, we revised the diagnosis as LD associated with PDA. The patient underwent transcatheter occlusion of the PDA and was discharged 3 days later. Unexpectedly, transcatheter occlusion resolved the paroxysmal chest pain in this case.

CONCLUSION

This is the first case report of LD combined with PDA. PDA should be considered in the list of differential diagnosis of chest pain. Several diseases characterized by left-ventricular apical protrusion with chest pain, such as LD, infarct aneurysm and takotsubo cardiomyopathy, can be misdiagnosed as one another. Therefore, it is important to familiarize clinicians with the differential diagnosis of these diseases.

摘要

背景

与动脉导管未闭(PDA)相关的左心室憩室(LD)极为罕见。我们尚未发现此前有这两种畸形并存的报道。这种伴有类似梗死性动脉瘤心绞痛或伴有胸痛的应激性心肌病的胸痛表现,在临床上难以鉴别。在此,我们讨论几种以左心室心尖部突出伴胸痛为特征的疾病,以使临床医生熟悉这些疾病的鉴别诊断。

病例介绍

一名58岁女性因主要在劳累时出现胸痛和呼吸困难而被转诊至我院。入院时心电图显示I导联有q波,aVL导联有Q波,肢体导联及V4至V6导联T波异常。经胸超声心动图显示有动脉导管未闭及左心室心尖部突出。入院诊断为动脉导管未闭和冠状动脉疾病伴梗死性动脉瘤。为评估胸痛的病因,进行了进一步检查。冠状动脉造影未发现异常。左心室造影证实存在心尖部收缩性膨出。基于这些发现,我们将诊断修订为与动脉导管未闭相关的左心室憩室。患者接受了动脉导管未闭的经导管封堵术,3天后出院。出乎意料的是,经导管封堵术解决了该病例的阵发性胸痛。

结论

这是左心室憩室合并动脉导管未闭的首例病例报告。在胸痛的鉴别诊断清单中应考虑动脉导管未闭。几种以左心室心尖部突出伴胸痛为特征的疾病,如左心室憩室、梗死性动脉瘤和应激性心肌病,可能会相互误诊。因此,让临床医生熟悉这些疾病的鉴别诊断很重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f550/4647487/0ea7ba8253a7/12872_2015_146_Fig1_HTML.jpg

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