Scott D D, King J C
Department of Rehabilitation Medicine, University of Colorado Health Science Center, Denver.
Arch Phys Med Rehabil. 1994 Jun;75(6):692-4. doi: 10.1016/0003-9993(94)90196-1.
A 77-year-old man who was undergoing comprehensive rehabilitation for a right subcapital femoral neck fracture presented with intermittent digital cyanosis of 3 days duration. He had no other cardiopulmonary signs or symptoms, therefore a diagnosis of Raynaud's Phenomenon was considered but ruled out because of no prior history of similar episodes or associated conditions. A ventilation-perfusion (V/Q) scan was obtained and was highly indicative of pulmonary embolus. Dopplers and impedance plethysmography (IPG) revealed a left lower extremity deep vein thrombosis. Heparinization resulted in cessation of the cyanotic episodes. Intermittent digital cyanosis as the sole presentation of pulmonary embolus has not been previously reported in humans. Pulmonary embolus is notoriously difficult to diagnose based on clinical signs and symptoms. Intermittent peripheral cyanosis should raise the index of suspicion for the possibility of pulmonary embolus.
一名77岁男性因右股骨颈头下型骨折接受综合康复治疗，出现持续3天的间歇性手指发绀。他没有其他心肺体征或症状，因此考虑诊断为雷诺现象，但由于既往无类似发作史或相关疾病史而将其排除。进行了通气灌注（V/Q）扫描，高度提示肺栓塞。多普勒超声和阻抗体积描记法（IPG）显示左下肢深静脉血栓形成。肝素化治疗后发绀发作停止。间歇性手指发绀作为肺栓塞的唯一表现此前在人类中尚未有报道。众所周知，基于临床体征和症状很难诊断肺栓塞。间歇性外周发绀应提高对肺栓塞可能性的怀疑指数。
