支原体肺炎合并肺栓塞一例临床分析

目的 探讨儿童支原体肺炎合并肺栓塞的诊断要点.方法 回顾性分析1例支原体肺炎合并肺栓塞的临床、辅助检查特点和随访情况,并复习文献,探讨支原体肺炎合并肺栓塞的诊断要点.结果 患儿男,6岁,以发热、咳嗽半月为主要表现.呼吸稍费力,胸痛.左侧胸部呼吸动度减弱,左下肺叩诊浊音,左侧呼吸音稍低,闻及少许细湿哕音.辅助检查:胸腔积液常规检查示混浊血性液,WBC 368×106/L,RBC 7140×106/L,N0.61,L0.12.酶联免疫法查支原体抗体IgM 1:128阳性,冷凝集素试验示1:1024阳性.血D-D二聚体14.81 mg/L.血抗心磷脂抗体阳性.血浆蛋白C活性60％(正常70％～ 130％).肺动脉血管造影示左肺下叶呈大片状密度增高影,左侧支气管动脉下支分支血管部分截断.心脏B超提示三尖瓣瓣口轻度反流,肺动脉收缩压约38 mm Hg(1 mm Hg=0.133 kPa).单光子发射计算机断层显像术示左肺背段、前基段、外基段、下舌段明显放射性分布稀疏.入院后考虑支原体肺炎伴胸腔积液、肺栓塞,予美洛培南针联合红霉素针抗感染,低分子肝素针和华法林片抗凝后胸腔积液消失,血D-D二聚体0.38 mg/L,肺动脉压力降低.随访显示抗心磷脂抗体转阴,血浆蛋白C活性恢复,肺部病变吸收.结论 支原体肺炎患儿有胸痛、呼吸困难、血性胸腔积液、肺动脉高压、抗磷脂抗体阳性、D-D二聚体增高时要考虑肺栓塞的可能,肺动脉血管造影可明确诊断.

Clinical analysis of pulmonary embolism in a child with Mycoplasma pneumoniae pneumonia

Objective To explore the essential points for diagnosis of pulmonary embolism in children with mycoplasma pneumonia.Method Retrospective analysis of the clinical and laboratory data of a pediatric case who developed pulmonary embolism after mycoplasma pneumonia was performed for the key points for diagnosis.Result A-six-year old boy was admitted with chief complaint of fever and cough for half a month,combined with chest pain and mild labored breath. Vital signs were stable. Breathing movement of the left side weakened and there was left lower lobe percussion dullness.Breath sound was found weakened in the left lung,and a few fine crackles were audible.The results of laboratory tests were as follows: mycoplasma antibody(IgM) 1:128,cold agglutinin test 1: 1024,blood D dimer 14.81 mg/L;anticardiolipin antibody was positive; plasma protein C activity was 60％ (normal range 70％ - 130％ ).Pulmonary artery computed tomographic angiography revealed a mass opaque shadow in left lower lobe,the branch of left lower bronchial artery was partially obstructed.Echocardiography showed tricuspid valve mild regurgitation,estimated pulmonary pressure was 5.1 kPa.Single-pohoton emission computed tomography indicated that radioactivity distribution was apparently sparse in the dorsal segment,anterior basal segment,outer basal segment and inferior lingular segment of the left lung.The preliminary diagnosis on admission was mycoplasma pneumonia with pleural effusion,pulmonary embolism.Intravenous erythromycin combined with meropenem were administered.Anticoagulation therapy was initiated with low molecular weight heparin and then oral warfarin tablets. Pleural effusion disappeared soon,D dimer descended to 0.38 mg/L,and pulmonary artery pressure declined.After 3-month follow-up,anti-cardiolipin antibody was negative,plasma protein C activity recovered,and lung lesions were absorbed.Conclusion When mycoplasma pneumonia is accompanied by chest pain or dyspnea and there are bloody pleural effusion,pulmonary hypertension,positive antiphospholipid antibody and elevated D dimer,pulmonary embolism should be considered.Diagnosis could be clarified by the result of pulmonary artery computed tomographic angiography.