Tetsuhara Kenichi, Tsuji Satoshi, Uematsu Satoko, Kamei Koichi
From the Division of Emergency Service and Transport Medicine and.
Department of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan.
Pediatr Emerg Care. 2018 Nov;34(11):e201-e203. doi: 10.1097/PEC.0000000000001104.
The diagnosis of pulmonary thromboembolism (PE) is often delayed because it is usually misdiagnosed as pneumonia or deep vein thrombosis. We report an unusual case of PE misdiagnosed as viral pleuritis on the first arrival at the emergency department (ED) in our hospital. A 14-year-old girl with no previous significant medical history was referred to the ED with pleuritic and chest pain with low-grade fever 4 days before admission. Echography showed a small amount of left pleural effusion. A 12-lead electrocardiogram was normal. She received a diagnosis of viral pleuritis. Two days before admission, she revisited ED with dyspnea and exacerbated pain. Echography showed slight increase in left pleural effusion. She had the same diagnosis. The chest pain remained at the same level. On the day of admission, she presented to ED with vomiting, watery diarrhea, abdominal pain, chest pain, and respiratory distress. Laboratory findings showed hypoalbuminemia and proteinuria. Echography showed a moderate amount of pleural effusion on both sides and no dilatation of the right cardiac ventricle. Contrast-enhanced chest computed tomography was performed to search the cause of the respiratory distress, which showed filling defects with contrast material in pulmonary arteries. A 12-lead electrocardiogram showed an S1Q3T3 pattern. She received a diagnosis of PE caused by nephrotic syndrome. Pulmonary thromboembolism can mimic infectious pleuritis and lead to misdiagnosis and/or delayed diagnosis. Thus, risk factors of PE should be considered in pediatric patients presenting with symptoms suggesting infectious pleuritis.
肺血栓栓塞症（PE）的诊断常常延迟，因为它通常被误诊为肺炎或深静脉血栓形成。我们报告了一例在我院急诊科首次就诊时被误诊为病毒性胸膜炎的罕见PE病例。一名既往无重大病史的14岁女孩在入院前4天因胸膜炎性胸痛伴低热被转诊至急诊科。超声检查显示少量左侧胸腔积液。12导联心电图正常。她被诊断为病毒性胸膜炎。入院前两天，她因呼吸困难和疼痛加剧再次就诊于急诊科。超声检查显示左侧胸腔积液略有增加。她得到了相同的诊断。胸痛程度维持不变。入院当天，她因呕吐、水样腹泻、腹痛、胸痛和呼吸窘迫就诊于急诊科。实验室检查结果显示低白蛋白血症和蛋白尿。超声检查显示双侧中等量胸腔积液，右心室无扩张。进行了胸部增强计算机断层扫描以查找呼吸窘迫的原因，结果显示肺动脉内有造影剂充盈缺损。12导联心电图显示S1Q3T3模式。她被诊断为肾病综合征所致的PE。肺血栓栓塞症可酷似感染性胸膜炎并导致误诊和/或诊断延迟。因此，对于出现提示感染性胸膜炎症状的儿科患者，应考虑PE的危险因素。
