异常Q波与原发性肝癌并发肺栓塞1例

One case of abnormal Q wave and primary liver cancer with pulmonary embolism

1病例资料 患者，男，44岁，因“上腹部阵发性胀痛20d，加重3d”，以“原发性肝癌”于2012—10-23收住我院肝胆外科。既往有乙肝病史13年，否认高血压、冠心病等病史。入院体检：体温、呼吸、血压以及心肺体征均正常；生化检查肿瘤标记物AFP99．9↑ng／ml；心电图示窦性心律，Ⅲ、aVF导联呈Qs型（图1）；上腹部MRI提示肝右叶原发性肝癌，肝内多发囊肿，脾大。

Summary A 44-year-old male had suitered from paroxysmal abdomlnal pain Ior 20 oays, which had been worse for 3 days. The admission ECG showed Q waves in Ⅲ , aVF lead. According to the presentation on MRI, the initial diagnosis was primary liver cancer. On the 2nd day after partial hepatectomy, the patient presented recurrent chest tightness and shortness of breath. The ECG manifested no dynamic changes in ST segment and T wave. The values of myocardial necrosis biomarkers and B type natriuretic peptide were normal, hut D-dimer was up to 1 755 μg/L. The results of computer tomography pulmonary angiography （CTPA） pointed to pulmonary embolism （PE）. Final diagnosis was primary liver cancer with PE.