D-二聚体正常肺栓塞病例的诊断与治疗分析1例

Diagnosis and treatment of a case of pulmonary embolism with normal D-dimer

患者为51岁女性,因"反复抽搐1月"入院,查体未见明显神经系统阳性体征,多次检测D-二聚体均在正常范围,脑部CT、脑电图等检查提示无明显异常。患者入院时出现持续低氧血症,遂行肺动脉灌注CT成像检查,结果示双侧肺动脉主干远端及各主要分支见血管充盈缺损,部分管腔狭窄闭塞,双侧肺动脉小分支可见广泛类似充盈缺损,最终确诊为肺栓塞。患者经华法林抗凝治疗后病情稳定。

The patient was a 51-year-old female.She was admitted to the hospital because of“repetitive convulsions for 1 month”.No significant neurological positive signs were found in the examination.D-dimer was in the normal range in several times of detection.Brain CT and electroencephalograph showed no obvious abnormality.Sustained hypoxemia occurred on admission,and CT imaging of pulmonary artery perfusion was performed.In the CT images bilateral distal main pulmonary arteries and their main branches showed vessel filling defect,partial lumen stenosis and occlusion,and bilateral small branches of pulmonary arteries showed extensive similar filling defect.Finally the patient was diagnosed with pulmonary embolism,whose condition was stable after anticoagulation therapy with warfarin.