肺栓塞误诊为肺部感染和胸腔积液28例分析

Analysis of Pulmonary Embolism Misdiagnosed to be Pulmonary Infection and Pleural Effusion in 28 Clinical Cases

目的:提高对肺栓塞(PE)的认识,减少其误诊率。方法:回顾性分析本院2003年1月至2006年12月肺栓塞误诊为肺部感染和胸腔积液28例的临床资料。结果:入院时误诊为肺炎2例,肺部感染16例,支气管炎、支气管扩张和慢性阻塞性肺气肿急性发作(AECOPD)各2例,胸腔积液查因4例。院内、外分别误诊18例和10例。28例中D-二聚体升高者26例。入院时X-线胸片:肺部炎症改变19例,并胸腔积液16例,肺结核1例,肺部肿块2例。螺旋CT:28例均有肺动脉栓塞改变,其中2例合并肺不张,4例合并心包积液。肺通气灌注扫描:12例均为阳性表现。结论:降低肺栓塞误诊率关键在于提高对本病的警惕性,对有肺栓塞高危因素者,如有可疑或无法解释的临床表现,及时筛查D-二聚体,阳性者高度怀疑肺栓塞,再行肺通气灌注扫描﹑螺旋CT扫描等检查进一步明确诊断。

Objective： To reinforce the knowledge on the disease of pulmonary thromboembolism（PTE）and descend the chance of fault diagnosis. Methods： The clinical data of 28 cases of PTE originally misdiagnosed as infection and pleural effusion from Jan 2003 to Dec 2006 were analyzed retrospectively. Results： 2 were misdiagnosed as pneumonia, 16 as infection of the lung, 2 as bronchitis, 2 as bronchiectasis, 2 as acute outbreak of chronic obstructive pulmonary disease and the remaining 2 as pleural effusions of unknown causes. Of the 28 cases, 18 were misdiagnosed in our hospital and 10 were not. 26 within 28 cases have a elevated D-dimer level. The first X-ray of the chest of our hospital were as follow： 19 cases have inflectional change, 16 were complicated with pleural effusion, 1 as pulmonary tuberculosis and 2 as pulmonary mass. The result of spiral CT： all of the 28 cases were positive for PIE, 4 cases were complicated with peficardial effusion. 12 were positive as pulmonary peffusion/ventilation scan by radionuclide. Conclusions： The key to decrease the misdiagnosis rate of PTE is to be alert to the disease. Patients with suspicion of PTE should complete the test of D-Dimer, for further confirmation, proceed the tests of pulmonary perfusion/ventllation scan by radionuclide and spiral CT.