肺栓塞误诊为肺部感染和胸腔积液28例分析

目的:提高对肺栓塞(PE)的认识,减少其误诊率。方法:回顾性分析本院2003年1月至2006年12月肺栓塞误诊为肺部感染和胸腔积液28例的临床资料。结果:入院时误诊为肺炎2例,肺部感染16例,支气管炎、支气管扩张和慢性阻塞性肺气肿急性发作(AECOPD)各2例,胸腔积液查因4例。院内、外分别误诊18例和10例。28例中D-二聚体升高者26例。入院时X-线胸片:肺部炎症改变19例,并胸腔积液16例,肺结核1例,肺部肿块2例。螺旋CT:28例均有肺动脉栓塞改变,其中2例合并肺不张,4例合并心包积液。肺通气灌注扫描:12例均为阳性表现。结论:降低肺栓塞误诊率关键在于提高对本病的警惕性,对有肺栓塞高危因素者,如有可疑或无法解释的临床表现,及时筛查D-二聚体,阳性者高度怀疑肺栓塞,再行肺通气灌注扫描﹑螺旋CT扫描等检查进一步明确诊断。

Analysis of Pulmonary Embolism Misdiagnosed to be Pulmonary Infection and Pleural Effusion in 28 Clinical Cases

Objective: To reinforce the knowledge on the disease of pulmonary thromboembolism(PTE)and descend the chance of fault diagnosis. Methods: The clinical data of 28 cases of PTE originally misdiagnosed as infection and pleural effusion from Jan 2003 to Dec 2006 were analyzed retrospectively. Results: 2 were misdiagnosed as pneumonia, 16 as infection of the lung, 2 as bronchitis, 2 as bronchiectasis, 2 as acute outbreak of chronic obstructive pulmonary disease and the remaining 2 as pleural effusions of unknown causes. Of the 28 cases, 18 were misdiagnosed in our hospital and 10 were not. 26 within 28 cases have a elevated D-dimer level. The first X-ray of the chest of our hospital were as follow:19 cases have inflectional change, 16 were complicated with pleural effusion, 1 as pulmonary tuberculosis and 2 as pulmonary mass. The result of spiral CT: all of the 28 cases were positive for PTE, 4 cases were complicated with pericardial effusion. 12 were positive as pulmonary perfusion/ventilation scan by radionuclide. Conclusions: The key to decrease the misdiagnosis rate of PTE is to be alert to the disease. Patients with suspicion of PTE should complete the test of D-Dimer, for further confirmation, proceed the tests of pulmonary perfusion/ventilation scan by radionuclide and spiral CT.