肺动静脉瘘二例误漏诊分析

Analysis of Misdiagnosis and Missed Diagnosis of 2 Patients with Pulmonary Arterio-venous Fistula

目的探讨肺动静脉瘘(pulmonary arteriovenous fistula,PAVF)的临床特点、诊断及治疗方法,减少临床误漏诊。方法回顾性分析2例PAVF误漏诊病例资料。结果例1分别于26个月及14个月前因突发头痛、抽搐、高热就诊外院,行头颅CT检查诊断为脑脓肿,行手术治疗;例2因发绀、乏力10余年,当地医院拟诊先天性心脏病,但心脏彩色多普勒超声检查未见结构异常。此后2例出现严重胸闷、气短,胸部CT检查发现肺部病变,进一步行肺动脉CT动脉造影(CTA)确诊PAVF(单纯囊状型),行经皮肺动静脉瘘封堵治疗,效果良好。结论 PAVF自然预后差,对于年轻、病因不明的脑脓肿和发绀患者要考虑PAVF可能,行CTA、数字减影血管造影或超声造影等检查可确诊。

Objective To investigate clinical characteristics, diagnosis and treatment of pulmonary arteriovenous fistula （PAVF） in order to reduce misdiagnosis and missed diagnosis rates. Methods Clinical data of 2 misdiagnosed patients with PAVF was retrospectively analyzed. Results One patient was admitted for gusty headache, convulsion and hyperpyrexia 26 and 14 months ago in another hospital, and was diagnosed as having brain abscesses by head CT examination, and then the patient received surgery. The other one was admitted for cyanosis and acratia for more than 10 years, and was misdiagnosed as having congenital heart disease in local hospital, but no cardiac structure abnormalities were found by heart color Doppler ultrasound examination. The 2 patients appeared severe dyspnea and shortness of breath later. Chest CT examination found pulmonary lesions, and PAVF was confirmed by further CT pulmonary artery of angiography examination. Treatments of percutaneous pulmonary arteriovenous fistula of interventional embolization and transcatheter closure showed good effects. Conclusion PAVF has poor natural prognosis, and therefore young patients with agnogenic brain abscess and cyanosis should he considered PAVF possible, and confirmed diagnosis can he given after CT angiography, digital subtraction angiography （DSA） or ultrasonic angiography examinations.