Pulmonary Thromboembolism Obscured by Coexisting Diseases: A Case Report and Literature Review

合併共存肺部疾病誤導之肺栓塞的診斷：病例報告及文獻回顧

林志鴻(Chih-Hung Lin) ； 邱銘煌(Ming-Huang Chiu) ； 柯文欽(Wen-Chin Ko)

《中華民國急救加護醫學會雜誌》 15卷2期 (2004/06) Pp. 81-88

https://doi.org/10.30018/JECCM.200406.0006

摘要

肺栓塞的診斷，通常需要謹慎的臨床懷疑作為起始點。當肺栓塞的診斷能儘快確立而有效之治療及早開始，則栓塞復發之機率極低，且罕見有因此死亡的病例。如果輕忽了臨床懷疑，病人有可能在短期內隨即惡化，甚至造成死亡。在此我們呈現一個以喀血為主要症狀至急診的病人，他的症狀雖似乎可以用陳舊肺疾病解釋，但後來卻證實與深層靜脈血栓有關，而且在抗凝血劑之治療下喀血症狀迅速痊癒。由此我們做一文獻回顧並探討如何在急診室中如何正確評估病人之肺栓塞臨床可能性，迅速為病人安排各式合乎經濟效益的檢查，綜合各檢查後確立或排除此診斷，並在適當之時機及早使用抗凝血劑治療，以期早日促進健康並避免此疾病造成死亡之機會。

關鍵字

肺栓塞 ； 喀血 ； 深部靜脈栓塞

並列摘要

A diagnosis of pulmonary thromboembolism requires careful clinical suspicion as an initial point. When diagnosis of an embolism is confirmed and effective therapy is initiated, recurrence of the embolism is rare and death is uncommon. If clinical suspicion is insufficiently keen, condition in patients may soon be exacerbated, leading occasionally to mortality. Herein we report on an 80-year-old man who presented with hemoptysis at the emergency room, which might have been explained by previous pulmonary disease. It was later proven to be related to deep vein thrombosis, and this symptom was soon alleviated by anticoagulant therapy. We also review the related literature and discuss how to evaluate the clinical probability of pulmonary thromboembolism and ways to arrange a series of cost-effective tests to confirm or exclude this diagnosis so that anticoagulants can be initiated early to promote health and avoid mortality.

並列關鍵字

pulmonary thromboembolism ； hemoptysis ； deep vein thrombosis