肺栓塞合并胸腔积液36例分析

目的提高对肺栓塞的认识,减少其误诊率。方法回顾性分析36例肺栓塞合并胸腔积液病例。结果94例肺栓塞中合并胸腔积液36例,占38%,其中少量积液30例,中等量积液4例,大量积液2例。双侧积液21例,右侧积液9例,左侧积液6例,心包积液4例。6例中、大量积液胸水检查,均为渗出性,其中4例为血性(2例为肺癌)。36例中D-二聚体升高35例;螺旋CT36例均有肺动脉栓塞改变,其中2例合并肺不张,4例合并心包积液。15例作肺通气灌注扫描均有阳性表现。结论肺栓塞是胸腔积液的常见病因之一,临床遇到不明原因的胸腔积液特别是血性积液,要考虑肺栓塞的可能,及时筛查D-二聚体,阳性者高度怀疑肺栓塞,再行肺通气灌注扫描﹑螺旋CT等检查进一步明确诊断。

Analysis of 36 Cases of Pulmonary Embolism with Pleural Effusion

Objective To improve on the understanding of pulmonary embolism aiming to reduce misdiagnosis rate.Methods Retrospective analysis of 36 cases of pulmonary embolism with pleural effusion for the past 4 years,combine with discussion after relevant literature review.Results 36 out of the 94 cases(38%)of pulmonary embolism had pleural effusion(38%),among which 30 cases were small effusion,4 were moderate effusion and 2 of massive effusion.Bilateral effusion was present in 21 cases,right sided effusion in 9,left sided effusion in 6 and pericardial effusion in 4 cases.Examination of hydrothorax review effusion in 6 moderate and massive effusion patients,4 were haemothorax(2 were associated with lung cancer).35 within 36 cases had an elevated D-dimer level.Spiral CT examination showed embolic changes of pulmonary artery in all 36 patients,with 2 cases of concomitant pulmonary atelectasis,and 4 cases of concomitant pericardial effusion.Pulmonary ventilation and perfusion scan in 15 cases showed positive test events.Conclusion Pulmonary embolism is one of the commonest etiology of pleural effusion;clinically,a possible diagnosis of pulmonary embolism should be taking in account when encountering pleural effusion of unknown origin and particularly when the pleural fluid bloody.In case of a positive timely D-dimer screening,pulmonary embolism should be highly suspected;further pulmonary ventilation and perfusion scan,as well as spiral CT scan should be performed in order to confirm the diagnosis.