Jany B
Missionsärztliche Klinik Würzburg, Akademisches Lehrkrankenhaus der Universität Würzburg, Salvatorstr. 7, 97074, Würzburg, Deutschland.
Internist (Berl). 2017 Jan;58(1):22-28. doi: 10.1007/s00108-016-0169-9.
Chest pain represents one of the most frequent symptoms of pulmonary diseases, in addition to dyspnea and cough. The broad differential diagnostics include the intensely painful but prognostically benign acute pleurisy as well as potentially life-threatening events, such as acute pulmonary embolism or malignant chest diseases. Primary spontaneous pneumothorax is characterized by acute chest pain. Pain associated with a respiratory infection, such as pneumonia rarely poses a difficult diagnostic problem. Painful diseases of the lungs can be differentiated in an initial approach by asking the patient if the pain is related to breathing, which is characteristic of pleuritic chest diseases. Pulmonary hypertension, lung cancer and mesothelioma show more constant pain unrelated to respiratory movements. It is most important to differentiate pain associated with acute exacerbation of chronic obstructive pulmonary disease (COPD), whereby a possible cardiac comorbidity, such as acute coronary syndrome (ACS) should always be considered.
胸痛是肺部疾病最常见的症状之一，此外还有呼吸困难和咳嗽。广泛的鉴别诊断包括疼痛剧烈但预后良好的急性胸膜炎，以及可能危及生命的情况，如急性肺栓塞或恶性胸部疾病。原发性自发性气胸的特征是急性胸痛。与呼吸道感染（如肺炎）相关的疼痛很少造成诊断难题。在初步诊断时，可通过询问患者疼痛是否与呼吸有关来区分肺部疼痛性疾病，这是胸膜炎性胸痛疾病的特征。肺动脉高压、肺癌和间皮瘤的疼痛更为持续，与呼吸运动无关。区分与慢性阻塞性肺疾病（COPD）急性加重相关的疼痛非常重要，此时应始终考虑可能的心脏合并症，如急性冠状动脉综合征（ACS）。
