主动脉夹层误诊为腰椎间盘突出症一例

1病例简介患者,男,69岁,主诉＂腰背部剧痛伴右下肢瘫痪3h＂于2011年4月26日凌晨5时急诊,予颅脑及腰椎CT扫描后拟＂L4~5腰椎间盘突出症＂收住骨科。患者入院前因上厕所解大便,其间突发腰背部及右下肢剧烈疼痛,随即出现右下肢麻木、瘫痪。无呕吐、视物模糊,无大小便失禁。既往体键     

盆腔包块伴发热

病历摘要 患者女，42岁。因右下肢肿胀、疼痛半年，发现盆腔包块1月余，于2008年7月18日入院。患者于入院前半年无明显诱因出现右下肢踝部水肿，逐渐上延至膝部及髋部，当地医院诊断为“静脉血栓”，对症治疗后好转。出院后出现右下肢疼痛。当地医院诊断为“风湿病”，治疗1月余，无明显好转。彩超检查发现盆腔内混合回声包块。查体：T37℃，BP120／90mmHg。皮肤黏膜无黄染，浅表淋巴结未扪及。心、肺无异常发现。腹部软，未扪及包块。     

妊娠期合并Ⅰ型主动脉夹层伴主动脉瓣关闭不全一例

患者，女性，35岁，因“反复胸背痛半年，加重伴呼吸困难3d”入院。患者半年前（怀孕25周）出现背痛，呈撕裂样疼痛，伴呕吐、大汗淋漓，持续约36h后缓解。当地医院诊断为前置胎盘。16d前（怀孕40周）患者又出现剧烈胸背部疼痛，左肩背更为显著，以前置胎盘急症行剖宫产术，患者术后自觉症状缓解。3d前患者因情绪激动再次出现背痛伴呼吸困难收入当地医院。病情逐渐加重，肢端发凉、发绀，少尿和低血压，静脉滴注多巴胺转入我院。     

糖尿病性肌萎缩进展为严重四肢瘫痪一例

患者男性,58岁,因"双下肢无力半年"于2008年7月1日收入院.患者曾于2008年1月出现双下肢无力,以右下肢近端明显,并进行性加重.入院时上下楼梯困难,能在平地独立行走,伴有大腿部肌肉跳动及深部疼痛,无麻木,无消瘦,无明显双上肢无力.     

Albright综合征一例报告

患者女性,39岁,1987年12月19日入院.患者1978年开始出现右侧胸背隐痛,以后逐年加重。于1985年X片提示右则一侧性多发性骨质纤维异样增殖症综合征.1986年9月上述部位的疼痛更为明显,常感憋气、胸闷,不能右侧卧位。同年12月出现右侧牙齿松动,阻嚼时不能用力.偶有腰痛,无尿痛、血尿;无甲状腺机能异常表现,月经正常。体检:发育正常,右侧颈、躯干及下肢有散在的形状、大小不一的褐色色素沉着,甲状腺大小正常,右胸锁关节局部隆起,胸骨及右侧1～9助偏后外部位有明显压痛,右髋关节有轻度压痛.实验室检查:二次     

病例154:谁撕裂了他的大动脉

<正>患者,男,41岁,某公司外籍职员。因撕裂样胸背部剧烈疼痛伴右下肢麻木无力6h急诊入院。既往有高血压与高血脂史,此次发病前正在公司开高层会议,突发胸背部疼痛后站起时右侧下肢麻木无力,同事将其送往附近医院就诊,当时查体发现血压185/120mm Hg(1mm Hg=0.133kPa),心电图示窦性心动过速;胸椎CT显示胸椎正常,血红蛋白120g/L,白细胞计数18×109/L,中性粒细胞87%;肌酸激酶1050U/L,肌     

主动脉壁内血肿一例

<正> 1 临床资料 患者男性,66岁,主因持续性胸背部剧痛2 d,于2003年5月28日入院。患者缘于入院前2d无明显诱因突然出现胸背部疼痛,为持续性剧烈闷痛,伴出汗。无头痛、恶心、呕吐,不伴晕厥、抽搐及肢体活动障碍。遂就诊于当地医院,给予哌替啶50 mg肌肉注射等治疗后疼痛无明显缓解,为进一     

奇静脉血栓所致大量血性胸水1例

<正>病例资料患者,女,42岁,因"右侧胸背部疼痛20~+天,加重伴呼吸困难5天"于2014年2月4日入院。既往史:发现血压升高3~+月,最高达180/?mm Hg,未正规监测及治疗,余无特殊,体型肥胖,适龄结婚及生育,G3P2,家族史无特殊。入院时查体:生命体征平稳,呼吸稍促,唇稍紫绀,右中下肺叩浊,呼吸音降     

肺结核误诊为肺隐球菌病1例

<正>临床资料患者女性,20岁,汉族,学生。因左侧胸背部疼痛半年于2013年3月入院。患者于半年前受凉感冒后出现左侧胸背部疼痛,为持续性钝痛,伴胸闷、盗汗,之后间断出现咳嗽、咳痰,发热,体温高达39.6℃,热型无规律,于当地医院治疗后未再发热,但左侧胸背部疼痛症状未缓解。患者曾于2013年1月在我科住院治疗,行纤支镜活检,病理示特殊染色支持隐球菌感染可能性大。并给以"氟康唑300     

第93例——双肺动脉内多发充盈缺损影

患者男性,25岁,因右下肢肿胀10 d,右侧胸痛2 d于2006年7月3日以急性肺血栓栓塞症(PTE)入院.患者入院前10 d出现右下肢红肿、疼痛,当地医院曾以"静脉炎"给予青霉素等治疗,但右下肢肿胀无好转.2 d前患者突发右侧胸痛(以深呼吸时明显并稍有气促),伴咳嗽(偶有血丝痰),右下肢肿胀明显而来我院门诊.2006年7月3日行下肢彩色多普勒检查显示右侧股总静脉、股浅静脉和腘静脉血栓形成(闭塞管腔),右侧髂外静脉远端附壁血栓形成(管腔狭窄).     

A case of cervical and mediastinal lymph nodes tuberculosis, tuberculous pleurisy, spinal caries and cold abscess in the anterior chest wall

A 61-year-old woman with schizophrenia that had been treated in a psychiatric hospital was admitted to our hospital because of subileus and back pain. Though subileus was improved, she had a sudden attack of fever 7 days later and developed right pleural effusion, a cold abscess in the anterior chest wall and swelling of a thumb-sized right cervical lymph node which broke through the skin. We made a diagnosis of cervical and mediastinal lymph nodes tuberculosis, tuberculous pleurisy, spinal caries and cold abscess in the anterior chest wall due to the biopsy findings of the specimen taken from the cervical lymph node, examination of pleural effusion, chest CT, bacteriological examination of the cold abscess and spinal MRI. We started chemotherapy with the antituberculous drugs (HRSZ) and symptoms except back pain improved. She complained of paresis of the both lower extremities, which completely paralyzed 8 months later in spite of continued chemotherapy. Thereafter her paralysis was gradually improved and she was able to walk by herself after 12 months chemotherapy.     

A case of pleural tuberculoma with intra-pulmonary invasion during anti-tuberculosis therapy

A 27-year-old woman who had been treated for pulmonary tuberculosis with anti-tuberculosis drugs for three months was admitted to our hospital because of pain in the chest and back. Chest CT showed improvement in the pulmonary tuberculosis lesions in the right middle lobe and S8, but there was a large pleural mass in the right lower lung field. Histopathological findings of the percutaneous biopsy showed epithelioid cell granulomas that were negative for acid-fast bacilli. We diagnosed the mass as pleural tuberculoma with intrapulmonary invasion. The pleural tuberculoma improved without any additional therapy.     

Vasospastic angina induced by prostaglandin F2 alpha.

A 56 year old woman underwent cholecystectomy. Postoperative paralytic ileus was treated with an intravenous infusion of prostaglandin F2 alpha. During infusion she complained of oppressive chest pain. This was accompanied by ST segment depression, and was relieved by sublingual glyceryl trinitrate. Coronary arteriography did not show significant stenosis, but subsequent intravenous infusion of prostaglandin F2 alpha provoked multiple segmental spasm of both the right and left coronary arteries.     

Sex differences in chest pain and prediction of exercise-induced ischemia

OBJECTIVES: To examine sex differences pertaining to pain characteristics in patients presenting to the ambulatory emergency department (ED) with nontraumatic chest pain and to the prediction of exercise-induced ischemia on a follow-up electrocardiogram. METHODS: This was a prospective study of 131 women and 202 men (mean age 58 years) consulting the ED with a chief complaint of chest pain. Seventy-eight women and 116 men underwent exercise stress testing following the ED consultation. Chest pain location, extension, intensity and quality were measured. Chest pain was classified as nonspecific, or typical or atypical of angina. RESULTS: Women received fewer 'typical' angina pain diagnoses (P<0.05), rated their pain as more intense (P<0.05) and used more affective words to describe their pain (P<0.05) compared with men. Pain in the posterior shoulder and middle back areas were more frequently reported by women (P<0.05). The presence of pain in the right anterior and posterior shoulder, as well as the absence of pain in the left anterior shoulder, predicted ischemia (P<0.05) in both men and women. Only in men, pain in the retrosternal and right middle back areas, as well as a classification of pain as typical or atypical, further contributed to the prediction of ischemia. CONCLUSIONS: Sex differences exist in the experience of chest pain and in the prediction of exercise-induced ischemia from pain variables. Further research on the unique symptomatology of men and women is needed to optimize their medical management.     

A case of Chlamydia pneumonia and systemic lupus erythematosus (SLE) pleurisy

A 40-year-old female was admitted with right chest pain. SLE was absent from her past history, although she complained of polyarthralgia in winter. Atypical pneumonia/pleuritis was suspected by chest X-ray film, showing a nodular shadow in the right lower field and moderate pleural effusion. Chlamydia pneumonia was diagnosed by elevated anti-C. psittsci antibody, while characteristics of pleural fluid revealed serositis accompanied by SLE because of the high titered anti-DNA antibody and the low titered complement. She was cured by clarithromycin and subsequent administration of prednisolone and cyclophosphamide.     

Empyema thoracic presenting as low back ache

A 24 years old female was presented with a 2 weeks history of fever (high grade), cough, fatigue, shortness of breath, chest pain right side and low back ache. Patient prefers to lie towards right side. CECT thorax reveals empyema thoracic with paravertebral extension. Patient was put on IV antibiotic according to culture and sensitivity. Clinical and Radiological improvement was evident after 1 week.     

Familial Mediterranean fever in a Taiwanese patient

Familial Mediterranean fever is a rare disease characterized by cyclic attacks of fever, serositis and strong family background. Here we report a 22-year-old man who suffered from recurrent fever accompanied by chest and abdominal pain for more than 10 years. The attack frequency was about once per 2-3 weeks. Although he consulted many clinics and even received appendectomy at the age of 15, no definite diagnosis was given. During the admission, many laboratory examinations failed to show any abnormality except mild leukocytosis and elevated C-reaction protein. Image studies including chest X ray and abdominal CT scan showed negative result but, interestingly, Gallium-67 scan showed a hot spot in right lower chest and right lower abdomen. After prophylaxis with colchicine 1.0 mg per day, he has enjoyed more than 2 years without the above symptoms.     

运动平板试验对不典型胸痛的诊断价值

目的探讨基层医院运动平板试验对不典型胸痛的诊断价值。方法分析2011年3-12月来我院就诊的不典型胸痛患者进行运动平板试验的临床资料。结果98例不典型胸痛患者的冠心病阳性率为60．20％。结论在基层医院中,运动平板试验可作为不典型胸痛患者诊断冠心病或判断预后的重要无创     

Spontaneous angina caused by spasm of the left coronary artery]

A 42 year old woman presented with a one year history of retrosternal chest pain and back pain on effort and at rest sometimes accompanied by minor syncopal attacks. Transient atrioventricular block was documented during one such episode associated with hypotension. Coronary angiography showed spontaneous spasm of the left main coronary artery with clinical symptoms but no electrocardiographic changes. The spasm was relieved by injection of SIN-1. The similarity between the previous clinical symptoms and those observed at coronary angiography was in favour of the diagnosis of spasm of the left main coronary artery without atherosclerotic coronary disease. Treatment with calcium atherosclerotic coronary disease. Treatment with calcium blockers and platelet antiaggregants led to total regression of her symptoms with a follow-up of 5 months.     

Terminal ileum gangrene secondary to a type Ⅳ paraesophageal hernia

Type Ⅳ paraesophageal hernia(PEH) is very rare, and is characterized by the intrathoracic herniation of the abdominal viscera other than the stomach into the chest. We describe a 78-year-old woman who presented at our emergency department because of epigastric pain that she had experienced over the past 24 h. On the day after admission, her pain became severe and was accompanied by right chest pain and dyspnea. Chest radiography revealed an intrathoracic intestinal gas bubble occupying the right lower lung field. Emergency explorative laparotomy identified a type Ⅳ PEH with herniation of only the terminal ileum through a hiatal defect into the right thoracic cavity. In this report, we also present a review of similar cases in the literature published between 1980 and 2015 in Pub Med. There were four published cases of small bowel herniation into the thoracic cavity during this period. Our patient represents a rare case of an individual diagnosed with type Ⅳ PEH with incarceration of only the terminal ileum.