非典型臨床症狀表現的肺動脈栓塞

Atypical Presentations in Patients with Pulmonary Embolism

楊博文(Por-Wen Yang) ； 顏鴻章(David Hung-Tsang Yen) ； 王立敏(Lee-Min Wang)

《中華民國急救加護醫學會雜誌》 18卷4期 (2007/12) Pp. 146-154

https://doi.org/10.30018/JECCM.200712.0002

摘要

肺動脈栓塞的臨床表現不具特異性，有時不易診斷。若病患有栓塞的危險因子，且出現典型的臨床症狀如呼吸困難、呼吸急促及肋膜性胸痛時，診斷較為容易；然而若出現非典型的臨床症狀而臨床評估系統計分屬於低或中可能性時，診斷較為困難。在此我們提出四例非典型臨床症狀表現，使用臨床評估系統計分多屬於低或中可能性，因此可能造成誤導診斷的肺動脈栓塞病患，強調即使出現非典型臨床症狀表現，若胸部X光出現輕微異常，仍應將肺動脈栓塞列入鑑別診斷，積極安排檢查，如此可以早期給予適當的治療，改善預後。

關鍵字

臨床表徵 ； 肺動脈栓塞

並列摘要

The clinical presentations of pulmonary embolism are varied and non-specific. It is often misdiagnosed or underdiagnosed in daily practice. Dyspnea, tachypnea and pleuritic chest pain are classic characteristics of pulmonary embolism. The diagnosis is facilitated when a patient with a risk factor presents with classic symptoms and signs. When a patient presents with atypical and limited symptoms or signs, the diagnosis of pulmonary embolism becomes even more challenging, especially if the clinical symptoms and signs suggest low or intermediate probability of this disease. We herein report on 4 cases of atypical presentation of pulmonary embolism. Clinicians should be alert to atypical presentations and include the diagnosis of pulmonary embolism on the basis of such findings. Our cases demonstrate the importance of pursuing the workup on patients with atypical presentations of pulmonary embolism, even if there is low clinical suspicion and nearly normal chest X-ray. These patients must be recognized to allow early and appropriate treatment that will lead to a good prognosis.

並列關鍵字

clinical manifestation ； pulmonary embolism