Dalen J E, Haffajee C I, Alpert J S, Howe J P, Ockene I S, Paraskos J A
N Engl J Med. 1977 Jun 23;296(25):1431-5. doi: 10.1056/NEJM197706232962503.
We compared 41 patients with angiographic proof of pulmonary embolism and clinical signs of pulmonary infarction (as evidenced by an infiltrate on x-ray study and pleuritic pain in the area of the embolus) with 24 patients with pulmonary embolism but without infarction. Only 18 of the 41 patients with pulmonary infarction had associated heart disease. Pulmonary infarction was uncommon when emboli obstructed central arteries but frequent when distal arteries were occluded. Follow-up x-ray examination showed that the infiltrates resolved in the patients with pulmonary infarction without heart disease, but persisted when heart disease was present. We suggest that obstruction of distal arteries results in pulmonary hemorrhage owing to an influx of bronchial arterial blood at systemic pressure. Hemorrhage causes symptoms and x-ray changes usually attributed to pulmonary infarction. However, hemorrhage resolves without infarction in patients without, but progresses to infarction in those with, heart disease.
我们将41例经血管造影证实有肺栓塞且有肺梗死临床体征（X线检查显示有浸润影以及栓子部位有胸膜炎性疼痛）的患者与24例有肺栓塞但无梗死的患者进行了比较。41例有肺梗死的患者中只有18例伴有心脏病。当栓子阻塞中央动脉时，肺梗死不常见，但当远端动脉被阻塞时则很常见。随访X线检查显示，无心脏病的肺梗死患者的浸润影消退，但有心脏病时浸润影持续存在。我们认为，远端动脉阻塞会导致由于支气管动脉血以体循环压力流入而引起肺出血。出血会引起通常归因于肺梗死的症状和X线改变。然而，无心脏病的患者出血可在无梗死的情况下消退，但有心脏病的患者出血会进展为梗死。
