从一例胸痛首发的Von Hippel-Lindau综合征谈胸痛鉴别诊断

Differential Diagnosis of Cheat Pain through a Von Hippel-Lindau Syndrome Patient with Chest Pain as the First Symptom

目的提高以胸痛为首发症状的脊髓肿瘤的诊断意识。方法回顾分析以胸痛为首发症状的Von Hippel-Lindau(VHL)综合征1例的临床资料。结果本例有糖尿病、高血压病史多年,因双侧胸部、肋腹部刺痛2周多次来我院就诊,先后就诊于7个专科,后经腹部CT检查示胰腺多个低密度结节影,部分伴斑点状高密度影,双肾多发囊性变;脊髓MRI检查发现脊髓占位性病变。并追问病史,初步诊断为脊髓肿瘤,经手术切除,术后病理检查诊断为脊髓血管母细胞瘤。综合分析病情最终确诊为VHL综合征。术后随访半年,胸痛症状消失。结论脊髓胸段肿瘤压迫神经可导致受压迫神经分布区域单侧或双侧胸部疼痛,在胸痛的鉴别诊断中应考虑病因可能为脊髓胸段肿瘤。

Objective To improve diagnostic awareness of spinal tumor with chest pain as the first symptom. Meth-ods Clinical data of a Von Hippel-Lindau （VHL） syndrome patient with chest pain as the first symptom was retrospectively analyzed. Results The patient had a history of diabetes mellitus and hypertensive disease for many years, and visited a doctor for bilateral chest and latus twinges for two weeks. The patient visited 7 departments. Abdominal CT scan showed several cysts in pancreas, part with mottling hyperdense shadow and multiple cystic changes in both kidneys. Myeloid occupying le-sion was found by magnetic resonance imaging （MIR） examination. Spinal tumor was preliminarily diagnosed after history ask-ing and surgical ablation. Spinal hemangiobulastoma was confirmed by postoperative pathological examination, and VHL syn-drome was confirmed after comprehensive analysis of the conditions. The patient was discharged, and did not have chest pain with follow-up for half a year. Conclusion Pars thoracica medullae spinalis tumors may induce single or bilateral chest pain of compression nerves, and clinicians should consider pars thoracica medullae spinalis tumors in differential diagnosis of chest pain.