左心衰竭的不典型肺部表现——附左心衰竭3例并文献复习

Atypical pulmonary manifestations of left heart failure

目的提高临床医师对左心衰竭的不典型肺部表现的认识。方法分析3例左心衰竭患者的胸片、CT、胸液等临床资料并进行文献复习。结果综合病史、化验检查及对治疗的反应,3例均诊断为左心衰竭引起的肺水肿。结论肺水肿是引起肺部阴影的常见原因之一,在鉴别诊断时,不要忽略了这一因素;心衰引起的胸腔积液经利尿剂治疗后,漏出液可变成“渗出液”假象。

[Objective] To raise the recognition of atypical pulmonary manifestations caused by left heart failure. [Methods] The chest radiograph, CT scan and pleural effusions in three patients were analysed. [Results] The three patients were diagnosed as pulmonary edema caused by left heart failure based on clinical information and response to treatment. The pulmonary manifestations included diffuse infiltrates in case 1,asymmetric ground-glass opacities in case 2 and pleural effusion with exudative characteristics in case 3. [Conclusions] Pulmonary edema presents variably on chest radiographs and CT scan. A transudative effusion may convert to exudate in patients re- ceiving diuretic therapy.