Nakano Y, Sato A, Tsuchiya T, Takeuchi E
Department of Internal Medicine, Kakegawa Municipal Hospital, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1996 Feb;34(2):200-3.
We describe a case of positional dyspnea due to compression of the tracheobronchial tree by an extensive thoracic aneurysm. In a 77-year-old woman with long-standing systemic hypertension, intermittent anterior chest pain gradually developed over several years. She had no history of asthma or thoracic trauma. She was admitted to our hospital because of sudden, severe shortness of breath. The breathlessness was markedly worse when she lay on her back or on her right side. On physical examination, she was in acute respiratory distress with cyanosis, severe hypertension (180/110 mmHg), tachycardia, and inspiratory stridor. A chest X-ray film showed loss of volume and nearly complete radiopacity of the left hemithorax. Arterial blood gas analysis revealed an arterial oxygen partial pressure of 54.8 mmHg, a carbon dioxide partial pressure of 39.8 mmHg, and an oxygen saturation of 84.5 percent on room air. Computed tomographic examination of the thorax showed dilation of the aortic arch and descending aorta, and marked compression of the trachea and the left main bronchus. Examination with a fiberoptic bronchoscope revealed extrinsic compression of the trachea just proximal to the carina. The patient's symptoms stabilized. However, she did not undergo surgery because of her age and because of the size of the aneurysm. She died due to rupture of the aneurysm.
我们描述了一例因广泛性胸主动脉瘤压迫气管支气管树导致的体位性呼吸困难病例。一名77岁患有长期系统性高血压的女性，数年来逐渐出现间歇性前胸疼痛。她无哮喘或胸部外伤史。因突发严重气短入院。当她仰卧或右侧卧位时，呼吸困难明显加重。体格检查发现她处于急性呼吸窘迫状态，伴有发绀、严重高血压（180/110 mmHg）、心动过速和吸气性喘鸣。胸部X线片显示左侧胸腔容积减小且几乎完全不透光。动脉血气分析显示在室内空气中动脉血氧分压为54.8 mmHg，二氧化碳分压为39.8 mmHg，氧饱和度为84.5%。胸部计算机断层扫描显示主动脉弓和降主动脉扩张，气管和左主支气管明显受压。纤维支气管镜检查显示在隆突近端气管受到外部压迫。患者症状稳定。然而，由于她的年龄和动脉瘤的大小，她未接受手术。她因动脉瘤破裂死亡。
