不典型主动脉夹层误诊的几点思考

目的分析临床表现不典型主动脉夹层（aortic dissection,AD）的误诊原因,并提出防范误诊的对策。方法对我院收治的2例临床表现不典型AD的临床资料进行回顾性分析。结果本组1例表现为腹腰痛在外院误诊为急性胰腺炎、急性胆囊炎等,1例因突发胸闷伴视物模糊入院误诊为冠心病,均经胸腹部CT确诊为AD,转上级医院治疗,1例病情好转出院,1例失访。结论 AD临床表现复杂多变缺乏特异性,首诊易误诊、漏诊,疑诊AD时仔细问诊和查体,及时选择相应的实验室和影像学检查,有利于提高早期诊断率,改善患者预后。

Reflection of Misdiagnosis of Atypical Clinical Manifestation of Aortic Dissection

Objective To analyze the cause of misdiagnosis of atypical clinical manifestation of aortic dissection(AD) and search for countermeasures to avoid misdiagnosis.Methods Retrospective analysis on clinical data of two cases of atypical clinical manifestation of AD was made.Results Symptoms of one case were abdominal pain,low back pain and was misdiagnosed by other hospitals as acute pancreatitis and acute cholecystitis.Another case was misdiagnosed as coronary atherosclerotic heart disease due to sudden chest distress with blurred vision.It was diagnosed as AD by CT scanning on chest and abdomen,and the patient was transferred to a higher level hospital for treatment.One patient recovered and was discharged,and the other patient was lost for follow up.Conclusion Clinical manifestation of AD is complex,variable and lacks specificity.Misdiagnosis and missed diagnosis often happen during initial diagnosis.When AD is suspected,inquiry of the patient’s history and careful physical check-up are needed,and appropriate laboratory and medical imaging examination can improve early diagnosis rate and prognosis.