原发性肥厚型心肌病误诊分析

原发性肥厚型心肌病（HCM）并非少见疾病，但因起病隐袭，病程进展缓慢且又缺乏典型临床表现，极易误诊为其他疾病。本文收集15年来我们收治的HCM67例，分析其中51例误诊病例，旨在提高对本病的诊断水平。1临床资料本组67例以首次入院诊断未包括HCM或仅诊断为并发症者作为误诊，全组误诊sl例，误诊率76．l％。51例中男39例，女12例；年龄18～83岁，平均年龄52岁。误诊疾病：急性心肌梗死Ic例，陈旧性心肌梗死2恫1．心绞痛6恫1．H心病心肌缺血或心律失常7例，高血压性心脏病5例，先天性心脏病6例，病毒性心肌炎3例，扩张型心肌病3例，风…     

B型超声对肾上腺醛固酮瘤定位诊断研究：漏,误诊原因分析

在经手术治疗疑有肾上腺醛固酮瘤的原发性醛固酮增多症２３８例中，超声定位诊断的敏感性、特异性和诊断正确率分别为９２．９８％、８１．２５％和９２．２１％。其中误诊（假阳性）３例占１．２６％。漏诊单瘤患者１１例，另有５例为同侧双瘤患者，超声均只检出其中之一，故共漏检肿瘤（假阴性）１６（１１＋５）个占７．０１％。文中针对失误原因进行分析讨论，旨在探寻提高诊断率的途径。     

新生儿先心病的彩超诊断

目的：评价彩色多普勒超声显像在新生儿先天性心脏病中的应用价值，重点对误诊的病例分析。方法：使用Au4彩色多普勒超声诊断仪，检查可疑先天性心脏病新生儿145例，并对其中的43例进行随访、尸解或手术证实。结果：43例中卵圆孔未闭19例，动脉导管未闭14例，室间隔缺损2例，法乐氏四联症3例，完全性心内膜垫缺损2例，复杂畸形2例，漏诊1例，彩色多普勒超声诊断符合率97．7％。结论：彩色多普勒超声诊断新生儿先天性心脏病直观、可靠、具有重要临床价值，漏诊原因与探查切面、探查手法密切相关。     

超声心动图与心导管检查在心脏外科术前诊断中诊断准确性的对…

为了对比超声心动图与心导管检查在心脏外科术前诊断中的诊断准确性，我们回顾性分析了１９８６年至１９９４年９年间在我院心脏外科行手术治疗患者的手术记录，超声和心导管报告，手术前既心导管又行超声检查的患者共２１７例，其中先心病２１０例（９６．７７％），瓣膜病４例（１．８４％）冠心病和预激综合征３例（１．３８％）术前诊断中心导管检查的例数随年度逐渐降低（ｒ＝－０．９２１）以手术所见为标准计算了超声和心导管     

彩色多普勒超声心动图对中老年先天性心脏病的诊断价值

目的 探讨中老年先天性心脏病的超声心动图特征，以便指导临床对中老年先天性心脏病的检查与合理治疗。方法 对63例中老年先天性心脏病患者应用彩色多普勒超声心动图进行多切面扫查，以显示房室大小、畸形部位及异常血流情况，判定有无肺动脉高压形成。结果 63例中老年先天性心脏病中，房间隔缺损（AsD）42例（66．67％），室间隔缺损（VSD）5例（7．94％），动脉导管未闭（PDA）3例（4．76％），其它类型先心病13例（20．63％）。其中，出现右向左分流者29例（46．03％）。结论 中老年先天性心脏病以房间隔缺损多见，异常的血流动力学致使心脏增大和心脏功能改变。对于房间隔缺损、室间隔缺损、动脉导管未闭等中老年先心病，一旦明确诊断且不伴肺动脉高压者，应建议患者尽早手术治疗，以延长生命，提高生活质量。     

44例肾结核误诊原因分析

４４例肾结核误诊原因分析汉寿县人民医院聂志强，张安选肾结核是常见的泌尿生殖系疾病，我院６年来共收治肾结核１１４例，其中第一次就诊诊断为肾结核者７０例（６１．４％），误诊或漏诊者４４例（３８．６％）。现就误诊原因分析如下。１临床资料１．１一般资料本组男...     

探讨小儿咳嗽变异性哮喘误诊原因分析

目的：探讨小儿咳嗽变异性哮喘的误诊原因，提高其诊断水平。方法：总结65例误诊病例临床资料，分析其误诊原因。结果：咳嗽变异性哮喘以长期反复性咳嗽为主要表现，缺少肺部体征，临床极易误诊，本组病例在本院确诊前均被误诊，其中误诊为支气管炎32例（49．2％），反复呼吸道感染19例（29．2％），支原体肺炎7例（10．8％），慢性咽炎4例（6．2％），白日咳2例（3．1％），原发性肺结核1例（1．5％）。结论：本病缺少临床体征，如果医生对该病的认识不足、询问病史不详、缺乏必要的辅助检查等是造成误诊的主要原因，减少误诊的关键是认识该病的特点，才能提高确诊率。     

多普勒超声估测的肺动脉收缩压对心脏外科手术患者的预后价值──八年的回顾性分析

为了评价多普勒超声心动图所测量的肺动脉收缩压对确定心脏外科手术预后的价值，我们回顾性地研究了1987年到1994年8年间在我院心脏外科行手术治疗患者的术后住院死亡率。共有1607例心脏外科手术患者于我院心内科应用连续波多普勒技术无创地测量了肺动脉压力。这些患者的术前诊断主要是先天性心脏病和瓣膜性心脏病。按超声心动图估测的肺动脉收缩压将患者分为四组：无肺动脉高压＜30mmHg（第1组），轻度30～＜50mmHg（第2组），中度50～80mmHg（第3组），重度＞80mmHg（第4组）。以此标准，无肺动脉高压者920例（57．25％），肺动脉压力轻度升高者200例（12．45％），中度升高者243例（15．12％），重度升高者244例（15．18％）。术后死亡率分别为5．98％、4．00％、6．58％和13．52％（第4组死亡率明显高于前三组，P＜0．05）。结论：超声心动图无创测量的肺动脉收缩压，对先心病和瓣膜病的心外手术的近期预后判断有重要价值，重度肺动脉高压的心脏疾病患者的手术住院死亡率明显高于无肺动脉高压及轻中度肺动脉高压的患者。     

青光眼误诊原因分析

青光眼是眼科常见病，居致盲眼病的第４位，其致盲原因主要与误诊、漏诊、失去最佳治疗时机有关。我院１９８９年１月～１９９６年７月误诊青光眼２０例（２８眼），占同期各类青光眼住院总数３１８例（３３５眼）的６．２６％。现将误诊病例报告如下。１临床资料１．１一...     

多平面经食管超声心动图诊断先天性心脏病的价值

为评价多平面经食管超声心动图（ＭＴＥＥ）在先天性心脏病中的诊断价值，在１５０例先心病患者进行了经胸超声心动图（ＴＴＥ）和ＭＴＥＥ的对比研究，结果显示：（１）在１３岁以上的患者，ＭＴＥＥ检查具有高度的安全世和成功率；（２）在７６例（５０．７％）的患者中，ＭＴＥＥ补充了ＴＴＥ的诊断，在９例（６．０％）的患者，ＭＴＥＥ则完全纠正了ＴＴＥ的诊断；（３）病变的最佳显示切面９０％以上是横切面和纵切面以外的斜切面；（４）在４０例手术治疗的患者中，ＭＴＥＥ与手术诊断的完全符合率为９０％，而ＴＴＥ与手术诊断的完全符合率仅为５０％。表明，ＭＴＥＥ对于多种先天性心脏病的诊断具有明显的优越性和独特的诊断价值。     

超声心动图与心导管检查在心脏外科术前诊断中诊断准确性的对比研究——九年的回顾性研究

为了对比超声心动图与心导管检查在心脏外科术前诊断中的诊断准确性，我们回顾性地分析了1986年到1994年9年间在我院心脏外科行手术治疗患者的手术记录，超声和心导管报告。手术前既行心导管又行超声检查的患者共217例，其中先心病210例（96.77%）;瓣膜病4例（1.84%）;冠心病和预激综合征3例（1.38%）.术前诊断中心导管检查的例数随年度逐渐降低（r=-0.921）;以手术所见为标准计算了超声和心导管的术前诊断准确率，超声正确而心导管误诊者21例（9.68%）,心导管正确而超声误诊者11例（5.07%）,两者均误诊者5例（2.30%）.配对卡方检验结果表明：超声与心导管诊断有相关关系（P<0.05）,两者的诊断准确率无显着性差异（P>0.05）.超声的诊断准确率为92.63%,心导管的诊断准确率为88.02%,两者联合诊断的诊断准确率为97.97%.经两个率的卡方检验可以认为联合诊断的诊断准确率高于单独一个诊断方法（P<0.001）.结论：在以先心病、瓣膜病为主体的心脏外科手术患者中，超声至少有与心导管检查相同的术前诊断准确率，从而无需再行创伤性的心导管检查；但在患有复杂先心病的少数患者，最好联合使用     

肾上腺肿瘤超声漏诊及误诊分析

目的：通过超声对185例肾上腺肿瘤诊断及漏诊、误诊病例分析,寻找影响肾上腺肿瘤超声漏诊及误诊的因素。方法：本文回顾性分析185例肾上腺肿瘤超声与病理的资料,对超声漏诊和误诊原因进行了分类、归纳和总结。结果：通过185例肾上腺肿瘤的超声检查,超声诊断出肾上腺病变122例,诊断正确率65．95％,明显低于相关文献报道,漏诊57例,误诊6例。漏误诊率（34．05％）,明显高于相关文献报道,综合分析其病理及影像学资料,将漏误诊原因归纳为五种：①左侧肾上腺肿瘤;②小于2．0cm的肿瘤;③混合性回声的肿瘤;④临床及超声医师对肾上腺肿瘤认识不足;⑤误诊的主要原因是由于肿瘤巨大,造成定位困难。结论：通过对肾上腺肿瘤漏诊及误诊分析,可以提高超声诊断的准确性,降低漏误诊率。     

成年人肺隔离症误诊分析

目的：探讨成年人肺隔离症误诊原因及预防。方法：回顾性分析1985—01～2002—12收治的成年人肺隔离症16例误诊的原因。结果：10例误诊，误诊率为62．5％。其中6例由基层医院首诊，误诊率为100％。误诊时间3个月～8a。结论：成年人肺隔离症的临床特征为非特异性，发病率低，临床医生对本病的认识不足是误诊的主要原因。认真仔细分析影像学资料，结合临床表现是减少误诊的关键。     

Injuries initially misdiagnosed as sprained wrist (beware the sprained wrist)

Objectives: To describe the injuries misdiagnosed as a sprain of the wrist and to determine the approximate incidence of misdiagnosis in patients diagnosed as having a sprain of the wrist.

Methods: All diagnostic errors in an accident and emergency (A&E) department were noted on a computerised database. Injuries initially misdiagnosed as wrist sprain are described and compared with the number of diagnoses of sprained wrist on the A&E department computer.

Results: 57 injuries initially diagnosed as a sprained wrist had a different diagnosis (1.76% of all diagnoses of sprained wrists). This is an underestimate of the true incidence of diagnostic error. Forty two per cent of the misdiagnoses were of greenstick or torus fractures of the distal radius.

Conclusions: Training for junior doctors in A&E departments should be improved—especially training in radiological interpretation. Other methods of preventing diagnostic errors by misreading of radiographs, for example, more hot reporting of radiographs by radiologists or radiographers should be considered.

     

The effect of a picture archiving and communications system (PACS) on diagnostic performance in the accident and emergency department

OBJECTIVE: A study has been conducted to identify the benefits to the accident and emergency (A&E) department of a hospital wide Picture Archiving and Communications System (PACS). METHODS: The study was conducted in two parts: firstly while the hospital was using conventional radiographic films, and secondly when the PACS was in operation. For each part of the study, the diagnoses of radiographic images made by A&E clinicians were compared with those made by radiologists. This resulted in the estimation of the incidence of false negative findings by the A&E staff. The management of patients with such findings was studied to identify those for whom a change of treatment was required. Such data for the two periods, when film and when PACS was used, were compared. RESULTS: It was found that the overall rate of misdiagnoses across all A&E patients who had radiography was low in both periods and there was a significant reduction when PACS was used (1.5% for film and 0.7% for PACS, 95% CI for difference between proportions: -0.014 to -0.0034), but the rate of serious misdiagnoses involving patient recall did not change significantly (95% CI for difference between proportions: -0.0059 to +0.0001). CONCLUSIONS: When PACS was used the diagnostic performance by A&E staff improved by reducing false negative interpretations but the rate of serious misdiagnosis did not change.     

阑尾炎的超声诊断及漏误诊原因分析

目的 探讨阑尾炎的超声诊断价值及漏误诊原因.方法 回顾性分析经手术病理确诊的69例阑尾炎患者的超声声像图,分析阑尾炎超声漏误诊原因.结果 69例阑尾炎,超声诊断符合率92.75%(64/69).其中单纯性阑尾炎17.39%(12/69),化脓性阑尾炎37.68%(26/69),坏疽性及穿孔性阑尾炎14.49%(10/69),阑尾周围脓肿7.24%(5/69),慢性阑尾炎急性发作4.35%(3/69),超声间接征象提示急性阑尾炎11.59%(8/69),漏诊2例,误诊3例.结论 超声对阑尾炎有较高的诊断价值.检查医师的技术、仪器质量、患者病情的复杂性及多样性是阑尾炎漏诊误诊的主要原因.     

Cross-sectional imaging of perforated gallbladder

Gallbladder perforation is a potentially life-threatening condition commonly seen as a complication of acute cholecystitis. Urgent surgical intervention is often needed to reduce serious morbidity and mortality. It presents a diagnostic challenge due to nonspecific symptoms, leading to a delay in diagnosis. Imaging plays a vital role in early identification of this potentially fatal condition and evaluation by more than one imaging modality may be required to make the diagnosis. Knowledge of specific and ancillary imaging findings is crucial to avoid misdiagnosis. In this article, we will review the risk factors, pathophysiology, and surgical classification of gallbladder perforation and discuss the role of multimodality imaging in its diagnosis. Differential diagnoses on imaging will also be discussed.     

64层螺旋CT在复杂先天性心脏病诊断中的应用

目的评估64层螺旋CT（MSCT）在复杂先天性心脏病（CCHD）诊断中的应用价值。方法回顾性分析32例CCHD患者的MSCT检查资料；其中男18例。女14例．平均年龄14．1岁。使用Philips Brilliance 64 64层CT机。双期扫描。11例患者采用回顾性心电门控。所有32例行超声心动图检查（ECHO），11例行心血管造影（CAG），手术25例。结果以手术或CAG检查为诊断标准，64层MSCT在复杂先天性心脏病心外大血管畸形方面诊断符合率为97．9％（46／47），明显优于超声心动图（ECHO）（X2=30．62，p〈0．001）；心内畸形诊断符合率88．4％（38／43），与ECHO差异无统计学意义（χ^2=2．87，p〉0．05）；心脏一大血管连接异常诊断符合率100％，与ECHO差异有统计学意义（χ^2=4．35，p〈0．05）。结论64层MSCT可有效检出心内和心外大血管畸形，在CCHD诊断中是一种准确的无创性方法。     

Evaluation of Missed Diagnoses for Patients Admitted from the Emergency Department

OBJECTIVE: To define a quality assurance instrument to evaluate errors in diagnostic processes made by physicians in the emergency department (ED). METHODS: This was a retrospective clinical investigation of inpatient ED records. Over a six-year period, 5,000 medical records of admitted patients were randomly selected for evaluation. Each record was initially examined by one of five physician evaluators. If the primary ED diagnosis differed from the primary discharge diagnosis, the ED record was inspected to determine reasons for the misdiagnosis. The authors considered several aspects of the diagnostic process, including patient history, tests ordered, interpretation of clinical data, choice and performance of procedures, injury pattern recognition, reasoning, and evaluation. Records that demonstrated errors in the diagnostic process were reevaluated for the same diagnostic process errors by a sixth physician. Disagreements regarding suspected errors in the diagnostic process were settled by discussion. Finally, to determine potential medical consequences of the misdiagnosis, one individual reviewed the complete medical records of patients whose ED medical records were scored with errors by both evaluators. Interevaluator reliability was assessed using Cochran's Q-test with a selected series of medical records. RESULTS: Twenty-eight records (0.6%) were found to contain one or more errors in the diagnostic process that contributed to misdiagnosis. For these patients appropriate diagnosis was not made until one to 16 days after admission. Three patients of 18 whose records were available for detailed review may have suffered complications that resulted, in part, from the delay in diagnosis and subsequent treatment. Significant interevaluator reliability for identification of errors in the diagnostic process was obtained (p > 0.1). CONCLUSIONS: A two-tiered evaluation of ED records selected by inconsistent initial and final diagnoses can be used reliably to screen for errors in the diagnostic process made by emergency physicians (EPs). The rate of physician error contributing to a misdiagnosis is very low, suggesting that EPs are delivering quality patient care.