CAJ | 학술논문

目的：通过分析肺动脉缺如患者的误诊过程,分析肺通气/灌注显像等肺栓塞确诊手段的特点。方法对我院收治的1例误诊为肺栓塞的右上肺动脉缺如病例资料进行回顾性分析,并针对指南推荐的肺栓塞确诊手段复习相关文献。结果本例为中年男性,以喘憋伴双下肢水肿3周余入院,经相关医技检查诊断为慢性阻塞性肺疾病、慢性肺源性心脏病、右心衰、肺动脉高压、重度阻塞性睡眠呼吸暂停低通气综合征,经肺通气/灌注显像提示双肺多发栓塞(累及5个肺段),补充诊断为肺栓塞,予华法林口服抗凝及对症支持治疗后病情缓解出院。13 d 后因咳嗽、咯血再次入院,急查国际标准化比率2.20,停用华法林后观察仍有咯血。行肺动脉、主动脉及支气管动脉造影示：右上肺动脉近段纤细、以远缺如,左下肺动脉纤细,平均肺动脉压35 mmHg,右下肺支气管动脉迂曲、扩张。修正诊断为右上肺动脉缺如,于病变支气管动脉近端行弹簧圈栓塞术,术后咯血停止。结论肺动脉缺如很难第一时间确诊,多因反复咳嗽、咯血、憋气就诊,常误诊为肺栓塞或支气管扩张等其他呼吸系统疾病,肺动脉造影是诊断该病的“金标准”。肺通气/灌注显像作为肺栓塞的排除性诊断手段对诊断肺动脉缺如价值有限,肺栓塞的诊断应基于医技检查前评估临床诊断的可能性,对高度可能者选择确诊手段,对低度可能者选择排除性诊断检查,最大限度避免肺栓塞的诊断不足和诊断过度。
목적：통과분석폐동맥결여환자적오진과정,분석폐통기/관주현상등폐전새학진수단적특점。방법대아원수치적1례오진위폐전새적우상폐동맥결여병례자료진행회고성분석,병침대지남추천적폐전새학진수단복습상관문헌。결과본례위중년남성,이천별반쌍하지수종3주여입원,경상관의기검사진단위만성조새성폐질병、만성폐원성심장병、우심쇠、폐동맥고압、중도조새성수면호흡잠정저통기종합정,경폐통기/관주현상제시쌍폐다발전새(루급5개폐단),보충진단위폐전새,여화법림구복항응급대증지지치료후병정완해출원。13 d 후인해수、각혈재차입원,급사국제표준화비솔2.20,정용화법림후관찰잉유각혈。행폐동맥、주동맥급지기관동맥조영시：우상폐동맥근단섬세、이원결여,좌하폐동맥섬세,평균폐동맥압35 mmHg,우하폐지기관동맥우곡、확장。수정진단위우상폐동맥결여,우병변지기관동맥근단행탄황권전새술,술후각혈정지。결론폐동맥결여흔난제일시간학진,다인반복해수、각혈、별기취진,상오진위폐전새혹지기관확장등기타호흡계통질병,폐동맥조영시진단해병적“금표준”。폐통기/관주현상작위폐전새적배제성진단수단대진단폐동맥결여개치유한,폐전새적진단응기우의기검사전평고림상진단적가능성,대고도가능자선택학진수단,대저도가능자선택배제성진단검사,최대한도피면폐전새적진단불족화진단과도。
Objective From collecting the diagnostic information of an absent pulmonary artery case to clarify the characteristics of the different diagnostic techniques for pulmonary embolism. Methods The detailed information of the diag-nostic procedure was retrospectively collected from an absent right upper pulmonary artery case, initially misdiagnosed as pul-monary embolism, and a review of the diagnostic techniques for the diagnosis of pulmonary embolism was conducted. Results A middle-aged man was admitted to our hospital for dyspnea on exertion and bilateral extremity edema for three weeks. After diagnostic procedures, the patient was diagnosed with chronic obstructive pulmonary disease, severe obstructive sleep apnea syndrome, cor pulmonale, pulmonary hypertension, and right heart failure. After lung scintigraphy, perfusion-ventilation mis-match was detected in 5 segments, and the patient was also diagnosed with pulmonary embolism. Warfarin was prescribed for anticoagulation, and the patient was discharged after symptom was relieved. 13 days later, he was hospitalized again for cough and hemoptysis. Laboratory test revealed that his international normalized ratio was 2. 20. Hemoptysis continued for several days after warfarin was stopped. Further assessments besides routine laboratory tests were performed. Pulmonary angiography revealed that the proximal of his right upper pulmonary artery was very thin and the distal was absent. The mean pulmonary ar-tery pressure was 35 mmHg. Bronchial artery angiography identified the hemoptysis associated with distortion and expansion of bronchial arteries in right lower lung and hemoptysis was stopped after bronchial artery embolization. Conclusion The diagno-sis of absent pulmonary artery is very difficult at the early stage. Patients with absent pulmonary artery often complain of cough, hemoptysis, and/or dyspnea. Absent pulmonary artery may be easily misdiagnosed as pulmonary embolism or other pulmonary disorders, such as bronchiectasis. Pulmonary angiography remains as the "gold standard" for the diagnosis or ex-clusion of absent pulmonary artery. The diagnostic value of lung scintigraphy is limited for absent pulmonary artery. The diag-nostic strategies for pulmonary embolism are based on pre-test probability. In order to avoid overdiagnosis and underdiagnosis,the diagnostic tests are recommended for possible cases of pulmonary embolism, and the excluding tests for less possible cases of pulmonary embolism.