脓毒性肺栓塞3例报告并文献复习

Septic pulmonary embolism：report of three cases and literature review

目的提高临床医师对脓毒性肺栓塞的认识及争取早期诊断和治疗。方法对3例脓毒性肺栓塞病例的临床表现、影像学特征、基础疾病、并发症、实验室检查等方面进行病例分析及文献复习。结果3例脓毒性肺栓塞均有发热、咳嗽、咯痰等症状。影像学上表现为双肺靠近胸膜处结节状、斑片状阴影等改变，2例伴有空洞，其中1例伴有气囊肿，2例伴有胸腔积液。基础疾病方面3例患者均通过心脏彩色多普勒确诊伴有感染性心内膜炎。并发症方面1例患者出现肾脏、眼底受损，2例患者伴有贫血。血培养仅有1例为阳性。结论脓毒性肺栓塞是一种少见但严重的疾病，无特征性的临床表现，影像学上常有靠近胸膜多发结节状斑片状影，伴或不伴空洞形成。多有感染性心内膜炎等基础疾病，可出现肾脏、眼底等栓塞并发症，血培养阳性率较低。早期诊断及治疗对提高患者预后具有重要意义。

Objective To improve the clinicians＇ understanding of septic pulmonary embolism （SPE） for early diagnosis and treatment. Methods The clinical manifestations, imaging characteristics, underlying diseases,complications, laboratory tests and others of three patients with SPE were analyzed and related literatures were reviewed. Results Three cases of SPE had fever,cough, and expectoration. The imaging features showed nodous and patchy shadows near the pleura of lung. Cavitations were found in two cases,in one of whom lung cysts were found. Pleural effusions were found in two cases. On the underlying disease, three cases were diagnosed to have infective endocarditis by color Doppler. On the complication,one case had damage of kidney and fundus oculi, two cases had anemia. Only one case had positive blood culture result. Conclusions SPE is a rare but serious disease, and has no characteristic clinical manifestation. The imaging feature is multiple nodous and patchy shadow near the pleura, with or without cavitations. Many patients with SPE may have underlying diseases such as infective endocarditis, and complicate with embolism in kidney and fundus oculi. The positive rate of blood culture is low. Early diagnosis and treatment are important to improve the prognosis of patients.