中老年甲亢性心脏病18例误诊分析

目的 探讨中老年甲亢性心脏病的临床特点及误诊原因。方法 对18例中老年甲亢性心脏病患者临床资料进行回顾分析。结果 中老年甲亢性心脏病的临床表现不典型且多样化。结论 系统问诊，查体，正确分析病情，检测血甲状腺激素及促甲状腺激素水平是避免误诊的关键。     

甲亢性心脏病176例临床分析

目的旨在分析甲亢性心脏病临床特征，探讨容易发生误诊因素。方法对176例甲亢性心脏病患者临床表现进行综合分析。结果此组病例心律失常、心脏扩大和心力衰竭发生率分别为86．8％、52．2％和23．8％。甲亢性心脏病的误诊率为15．4％，多发生于无高代谢综合征的老年患者。结论甲亢性心脏病不伴高代谢综合征表现的病例临床容易误诊；对原因不明的心律失常、心脏扩大或心力衰竭的老年患者，应注意甲状腺功能检查。     

甲亢性心脏病22例误诊原因分析

甲状腺机能亢进性心脏病是甲状腺机能亢进最常见的并发症之一，由于有些甲亢性心脏病病人缺乏典型的甲亢的临床表现，故容易误诊，现将我院2003年以来22例误诊病例的原因分析如下。     

甲状腺功能亢进性心脏病3例误诊分析

甲状腺功能亢进性心脏病 (甲亢性心脏病 )如缺乏甲亢的典型表现 ,易被误诊。我们曾收治 3例甲亢性心脏病被误诊者 ,现报告如下并回顾性分析其误诊原因。例 1:女 ,5 9岁 ,因劳累性呼吸困难 3个月伴心悸 ,并有夜间阵发性呼吸困难而就诊。曾在外院诊断为风湿性心脏病 ,房颤。服用地高辛、氢氯噻嗪等药物 ,症状无改善。查体 :Bpl4 0 /60 mm Hg( 1mm Hg≈ 0 .13 3 k Pa) ,肥胖体型 ,甲状腺无肿大。双肺检查无异常发现 ;心界向左下扩大 ,心室率 10 2次 /分 ,,心律绝对不齐 ,第 1心音强弱不等 ,心尖部可闻及隆隆样舒张期杂音。心电图示房颤。 X线…     

47例甲亢性心脏病临床分析

为了解甲亢性心脏病的临床特点,我们对本院的47例甲亢性心脏病住院患者的临床资料进行了回顾性分析,现将结果报告如下。     

14例心源性胸腔积液误诊分析

目的　分析心源性胸腔积液的误诊原因。方法 对 14例心源性胸腔积液患者的临床特征进行回顾性分析。结果 (1) 45岁以上 12例,平均年龄 59.4岁。 (2) 10例患者有夜间阵发性呼吸困难、心界增大、肝大触痛、下肢水肿,8例病人有颈静脉怒张等心衰症状体征。 (3)心电图均有ST-T改变,提示心肌缺血或劳损,合并心律失常 10例。 (4)胸部X线或CT示全部病例均有不同程度的间质性或 /和肺泡性肺水肿影像。心影增大 10例,双侧胸腔积液 13例。胸液细胞计数多不符合典型漏出液改变。 (5)临床诊断:冠心病 8例 (其中合并心包炎 1例,高血压病 3例)、心肌病、肺心病各 2例、甲亢性心脏病、高血压性心脏病各 1例。全部病例均合并肺部感染和充血性心力衰竭。结论 心源性胸腔积液多见于中老年,均存在引起或诱发心力衰竭的基础疾病和诱因。常多种疾病并存,相互影响,掩盖或加重心脏的症状或体征,影响胸液检查结果,导致诊断困难。认真、严密、细致的临床观察和对病史、临床资料的综合分析可防止误诊。     

甲亢性心脏病发病机理研究进展

综述近年来有关甲亢性心脏病发病机理的研究进展。     

以胸腔积液为首发症状的淋巴瘤12例临床分析

目的:提高对以胸腔积液为首发症状的特殊类型淋巴瘤的认识。方法:回顾性分析12例以胸腔积液为首发表现,疑似"结核性胸膜炎",最后经手术病理检查、胸水细胞学检查及追踪确诊为淋巴瘤患者的临床资料。结果:12例患者均以胸腔积液为首要表现,1例伴有腋窝淋巴结肿大,其余11例无其他淋巴组织损害,胸水均为渗出液,最后经胸水细胞学、手术病理检查及追踪诊断为淋巴瘤。结论:少数淋巴瘤患者以胸腔积液为首发表现,可能与原发于胸膜淋巴组织有关,诊断困难,易误诊为结核性胸膜炎。对抗结核治疗反应欠佳且胸水腺苷脱氨酶明显增高者,应特别警惕淋巴瘤可能,宜尽快行胸腔镜检查明确诊断。     

以胸腔积液为主要表现的糖尿病心脏病一例

1　病例报告患者 ,女性 ,70岁 ,退休工人。因咳嗽、胸闷、气促 3个月 ,加重半个月 ,于 2 0 0 3年 5月 17日入院。患者于 3个月前出现咳嗽 ,咯少许白痰 ,胸闷气促 ,活动后明显 ,曾于 2 0 0 3年 2月 7日及 4月 2 7日两次到当地医院住院治疗 ,诊为 :“两侧胸腔积液”,多次抽胸水均为漏出液 ,予抗炎、对症治疗 ,症状好转不明显。近半月来症状加重 ,夜间不能平卧 ,并常需坐起及吸氧后症状才稍有缓解 ,故转来本院就诊。患者有 型糖尿病病史 10余年 ,服用二甲双胍、美吡哒 ,血糖控制不理想 ,近一年来改用皮下注射诺和灵 ,早餐前及晚餐前半小时各注…     

甲亢性心脏病发病机理研究进展

：综述近年来有关甲亢性心脏病发病机理的研究进展。     

Pleural effusion in patients with pulmonary embolism

Background and objective: It has been suggested that pulmonary embolism (PE) is an under‐recognized cause of pleural effusion. This study aimed to (i) establish the incidence and clinical relevance of pleural effusion in patients with pulmonary emboli; and (ii) determine if there is a relationship between development of pleural effusions and the location of emboli and number of pulmonary arteries involved. Methods: A retrospective analysis of all CT pulmonary angiograms (CTPA) performed over 12 months on adult patients with clinically suspected PE in a hospital which used CTPA as first‐line imaging investigation for PE. Results: Of 285 CTPA, 60 patients (21%) had evidence of pulmonary emboli (38 had both central and peripheral clots and 22 peripheral emboli only). Emboli were bilateral in 39 cases and unilateral in 21 cases. Pleural effusion was present in almost one half (n = 29, 48%) of the patients with pulmonary emboli. Patients with pulmonary emboli were more likely to have a pleural effusion (OR 2.2 (95% CI: 1.1–4.7), P < 0.05) than patients without PE; however, the effusions were generally very small. Most (86%) of the effusions were present on the same side as the emboli. The location of emboli and number of arteries involved did not predict the presence of pleural effusions. Conclusions: Pleural effusion is common in patients with pulmonary emboli demonstrated on CTPA. These effusions are small and seldom alter clinical management. Clinicians should therefore have a high threshold of suspicion in attributing large or contralateral pleural effusions to embolic diseases without excluding alternative diagnoses.     

Pleural effusion as a result of chronic renal ischemia

We would like to present a case of patient with a transudative pleural effusion as a result of atherosclerotic occlusion of renal arteries. About 50 liters of fluid were drained from the right pleural cavity during 10 months period of observation. Successful revascularization of kidneys improved left ventricular function, stabilized hemodynamic of the pulmonary circulation and thus led to elimination of pleural effusion.     

老年人胸腔积液32例鉴别诊断分析

目的探讨老年人胸腔积液的鉴别诊断。临床资料32例胸腔积液患者,年龄55～80,平均70岁。心衰16例,肺癌2例,结核性胸膜炎9例,脓胸2例,液气胸3例。讨论老年人胸腔积液必须注意心衰、结核、肿瘤、系统性疾病的鉴别诊断。     

Pleural amyloidosis in a patient with intractable pleural effusion and multiple myeloma

Pleural involvement of systemic amyloidosis has been rarely reported. We report a case with multiple myeloma presenting an intractable right pleural effusion, in which pleural amyloidosis was diagnosed through pleural biopsy using a Cope needle. The diagnosis of pleural amyloidosis is important, because its refractory pleural effusion should be treated with pleurodesis. Since closed pleural biopsy using a Cope needle is much less invasive than thoracoscopy, the former should be attempted first whenever pleural amyloidosis is suspected.     

中性肽链内切酶对心衰所致胸腔积液的诊断价值

目的探讨胸腔积液中性肽链内切酶(neprilysin,NEP)浓度变化及其对心衰所致胸腔积液的诊断价值。方法 88例胸腔积液住院患者纳入研究,根据病因分为心衰组胸腔积液25例,类肺炎组胸腔积液21例,结核组胸腔积液21例及肿瘤组胸腔积液21例,酶联免疫吸附法测定胸腔积液NEP浓度。结果 (1)心衰组NEP浓度显著低于其他组(P0.001),类肺炎组和肿瘤组NEP浓度无显著差异(P0.05),均显著低于结核组(P0.001)。(2)胸腔积液中NEP浓度和血清脑钠肽(brain natriuretic peptide,BNP)含量呈负相关(r=-0.570,P0.001)。(3)ROC曲线显示NEP浓度271 pg/mL为临界值诊断心衰所致胸腔积液灵敏度为76%,特异度为92.06%。胸腔积液NEP联合血清BNP诊断心衰所致胸腔积液灵敏度为98.1%,特异度为98.4%。结论心衰所致胸腔积液中NEP分泌降低,对诊断心衰有一定参考价值;胸腔积液NEP联合血清BNP可提高心衰诊断的灵敏度和特异度。     

以胸腔积液为首诊的肺栓塞19例临床分析

目的分析以胸腔积液为首诊的肺栓塞患者的临床特点,增强对症状不典型肺栓塞的认识,降低误诊率。方法回顾性分析19例以胸腔积液为首要临床表现的肺栓塞患者的临床特点。结果 71例肺栓塞患者中19例出现胸腔积液,占26.76%;大量胸腔积液1例,中量2例,少量16例;双侧胸腔积液2例,单侧胸腔积液17例,其中右侧8例,左侧9例;3例行胸腔穿刺胸水常规化验均为渗出性胸水。结论胸腔积液是肺栓塞的非典型、非特异性临床表现,临床上要提高警惕,及时完善D-二聚体检测,CT肺动脉造影检查,以提高确诊率。     

Pleural amyloidosis as the first sign of IgD multiple myeloma

We describe a case of IgD myeloma with amyloid and plasmocytic pleural localisations. At the onset of the disease it mimicked rheumatoid arthritis, which can be the first presentation of both AL amyloidosis and multiple myeloma. Pleural effusion can happen first in IgD myeloma, but our observation is of interest in that it confirms the very rare possibility of pleural amyloid and plasmocytic localisations devoid of pleural effusion.     

老年冠心病漏诊和误诊临床分析

目的分析老年冠心病误诊的原因,以减少误诊。方法采用回顾方法分析2007年1月至2009年12月17例发生冠心病漏诊和误诊患者的临床资料。结果 17例患者中冠心病误诊为消化道疾病5例,咽炎1例,心神经官能症1例,颈椎病1例;其他疾病误诊为冠心病的有带状疱疹3例,胆囊炎2例,心尖部肥厚性心肌病1例,主动脉夹层动脉瘤1例,早期复极综合征2例。结论老年冠心病患者临床表现不典型,同时身患多种疾病,需全面分析、仔细鉴别,及时进行相关检查,减少误诊。