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。

Analysis on misdiagnosis of 14 cases with cardiac pleural effusion

Objective To analyse the misdiagnosis reason of cardiac pleural effusion.Methods To analyse clinical symptoms of 14 cases with cardiac pleural effusion retrospectively.Results (1)The patients over 45 years old were 86%,whose average age was 59.4 years.(2)71% of cases had paroxysmal dyspnea at night, enlarged heart, enlarged liver with tenderness, edema with legs and feet.57% of cases had heart failure symptoms and signs such as vena jugular enlargement.(3)All of cases had ST-T change and showed lack of blood and cardiac muscles hurt in electrocardiogram,71% of cases had cardiac arrhythmia.(4)All of cases showed different edema image of lung interstitial or/and alveolar in chest X-ray and CT.71% of cases had cardiac image enlargement,93% of cases had two lateral pleural effusion. 92% of cases of cell members were not typical pleural effusion.(5)Clinical diagnosis: 8 of 14 cases were coronary atherosclerotic heart disease.One case with pericarditis,three cases with hypertension.), two of cardiomyopathy disease, two of pulmonary heart disease,one of hyperthyroidism heart disease,one of hypertension heart disease. There were 14 cases of pneumonia and congestive heart failure.Conclusion Cardiac pleural effusion was found in the middle age and old age patients commonly. All of them combined with some basic diseases which could lead to heart failure. Many diseases consist at the same time, impact each other, cover or lead to more serious heart symptoms and signs, effect the examination result of pleural effusion, which make the diagnosis more difficult. Serious clinical observation and analysis of the disease history and clinical imformation could prevent from misdiagnosis.