原发性肺动脉肉瘤误诊为肺血栓栓塞症原因分析

Causes of misdiagnosis of primary pulmonary artery sarcoma as pulmonary thromboembolism

目的提高对原发性肺动脉肉瘤(PAS)的认识和早期诊治率。方法结合3例肺动脉肉瘤患者的的临床资料和国外有关文献,对肺动脉肉瘤及肺血栓栓塞症(PTE)的临床特点进行分析。结果肺动脉肉瘤的临床表现和肺血栓栓塞症相似,但前者多有发热、体重下降,无下肢深静脉血栓形成,胸部增强CT显示肺动脉扩张,主肺动脉及左、右肺动脉内大量肿块阴影,管腔外肿块阴影,溶栓抗凝治疗无效等,确诊需手术。结论肺动脉肉瘤易误诊为肺血栓栓塞症,临床医师应提高认识。

Objective To improve the understanding of primary pulmonary artery sarcoma （PAS） and the rate of early diagnosis and treatment. Methods According to the clinical data of 3 PAS patients in Beijing Anzhen Hospital and related literature, the clinical features, diagnosis and therapy of the disease were retrospectively studied. Results Pulmonary artery sarcoma had similar clinical presentations to pulmonary thromboembolism （PTE）. However, fever and weight loss were more common in PAS. When the patients had no deep venous thrombosis, chest contrast-enhanced CT angiography revealed enlarged pulmonary artery and massive lumps in main pulmonary trunk, and clinical deterioration occurred after thrombolytic and anticoagulant therapy. At that time, pulmonary artery sarcoma should be given primary consideration in patients with suspected PTE. The confirmed diagnosis needed the operation. Conclusion Pulmonary artery sarcoma can be easily misdiagnosed as PTE. The clinicians should increase the recognition of PAS.