以单侧胸腔积液为首发表现的多发性大动脉炎一例并文献复习

Unilateral pleural effusion as first manifestation in Takayasu arteritis： a case report and review of literature

目的 提高对累及肺动脉的多发性大动脉炎的临床表现、胸部影像学表现及病理组织学的认识.方法 对1例诊断为以单侧胸腔积液为首发表现的多发性大动脉炎患者的临床表现、影像学资料,结合有关文献进行回顾性分析.以“多发性大动脉炎、胸腔积液”及“Takayasu arteritis”和“pleural effusion or hydrothorax”为检索词在万方、维普、中国知网及PubMed数据库检索相关文献并进行分析.结果 患者女性,58岁.首发临床表现为活动后气喘,影像学表现为双侧肺门影增大,左侧胸膜腔积液.病程中出现双上肢血压测不出,主动脉及肺动脉造影证实肺动脉及锁骨下动脉均有不同程度受累,诊断为多发性大动脉炎.经激素治疗后胸腔积液生成速度减缓,最终吸收,且呼吸衰竭纠正.经文献检索共检索到4例合并有单侧渗出性胸腔积液的多发性大动脉炎患者,3例女性,1例男性,年龄32 ～ 35岁,临床主要表现为发热、胸痛及咯血,经激素治疗后均有好转.结论 以单侧胸腔积液为首发表现的多发性大动脉炎容易误诊为肺部本身疾病引起的,锁骨下动脉可闻及收缩期杂音并出现“无脉”体征,及时进行血管造影可明确诊断.

Objective To highlight the characteristics of pulmonary arterial involvement in Takayasu arteritis.Methods The clinical and radiological data of a patient with Takayasu arteritis presenting with unilateral pleural effusion were studied and relevant literature was reviewed.The key words,“Takayasu arteritis＆quot;and ＆quot;pleural effusion”were analyzed through literature retrieval in databases.Results This 58 year-old female patient presented with shortness of breath.The chest CT scan showed bilateral hilar enlargement and pleural effusion on the left side.The blood pressure was not measurable in the course of the disease.After the aorticopulmonary-arteriography,we found that the pulmonary artery and the subclavian artery were involved.The diagnosis of Takayasu arteritis was made,and glucocorticoid therapy was initiated,with significant clinical and radiological improvement after therapy.Literature review found 4 cases of Takayasu arteritis with unilateral pleura effusion,ranging from 32 to 35 years of age,with a female predominance（Female：Male =3：1）.The chief complaints were fever,chest pain and hemoptysis.All the patients recovered after the treatment of glucocorticoids.Conclusions Takayasu arteritis presenting with unilateral pleural effusion was easily misdiagnosed as primary pulmonary diseases.Careful physical examination and timely angiography can be used to make the diagnosis.