|
曾经，一看到肺动脉CTA上有充盈缺损，就大呼：肺栓塞了，肺上长血栓了！立马抗凝、对症治疗。 后来发现，肺动脉造影才是金标准。我就纳闷：肺动脉CTA上发现了充盈缺损，那不是血栓会是神马？ 再后来，内科学第八版第103页：肺动脉造影诊断肺栓塞的特异性是95%-98%。我就更纳闷了，肺动脉造影作为金标准，为什么还会误诊肺栓塞？特异性居然不是100%。 再后来，我知道癌栓。但是除了手术活检，其他办法是不可能很准确地鉴别癌栓啊，还是得抗凝啊。 曾经有人问我：肺栓塞老是治不好，为什么？我知道很多原因，但是我居然不知道一个很简单的原因：肺栓塞治不好，有可能那根本就不是肺栓塞！ 看了很多文献，才发现，自己曾经真的是too young，too simple。 年轻不知晓，缺损都栓了。 夜来看文献，误诊知多少。 为此，我来写写肺栓塞CTA葵花宝典残页，为什么叫残页呢？我只是分享一些经验，还木有水平写整本葵花宝典。    
参考文献： [1]Adekolu O, Lundbye J, Manthous C. Pulmonary artery sarcoma masquerading as pulmonary embolism[J]. American Journal of Respiratory & Critical Care Medicine, 2013, 188(9):1161. DOI: 10.1164/rccm.201304-0715IM. [2]Bourry N, Chabrot P, Jeannin G, et al. [Pulmonary artery intimal sarcoma].[J]. Journal Des Maladies Vasculaires, 2008, 33(1):39-44.PMID: 18384993 DOI: 10.1016/j.jmv.2008.01.107. [3]Dornas A P, Campos F T, Rezende C J, et al. Intimal sarcoma of the pulmonary artery: a differential diagnosis of chronic pulmonary thromboembolism.[J]. Jornal Brasileiro De Pneumologia Publicaao Oficial Da Sociedade Brasileira De Pneumologia E Tisilogia, 2009, 35(8):814.PMID: 19750336。 [4]Trübenbach J, Pereira P L, Huppert P E, et al. Primary choriocarcinoma of the pulmonary artery mimicking pulmonary embolism.[J]. British Journal of Radiology, 2014, 70(836):843-845.PMID: 9486052 DOI: 10.1259/bjr.70.836.9486052. [5]Siu C W, Jim M H, Tse H F. Pulmonary artery obstruction mimicking the clinical features of acute pulmonary embolism.[J]. Heart, 2005, 91(2):212.doi: 10.1136/hrt.2004.037036. [6]Renilla A, Fernándezvega I, Martín M, et al. Pulmonary artery sarcoma mimicking a pulmonary embolism[J]. Indian Journal of Cancer, 2013, 14(10):1025.doi:10.1093/ehjci/jet061. [7]Batista M N, Barreto M M, Cavaguti R F, et al. Pulmonary artery sarcoma mimicking chronic pulmonary thromboembolism[J]. Radiologia Brasileira, 2015, 48(5):333-334. [8]Delany S G, Doyle T C, Bunton R W, et al. Pulmonary artery sarcoma mimicking pulmonary embolism[J]. Chest, 1993, 103(5):1631-3. [9]Yamamoto K, Nozue T, Tsuchida M, et al. Pulmonary Embolism Caused by Intimal Sarcoma of the Pulmonary Artery[J]. Internal Medicine, 2012, 51(21):3031.DOI: 10.2169/internalmedicine.51.7558. [9]Annoni A D, Formenti A, Pontone G, et al. Ruptured unknown Stanford Type A aortic dissection with huge mediastinic emathoma mimicking pulmonary embolism.[J]. European Heart Journal Cardiovascular Imaging, 2014, 15(6):710. [10]Stougiannos P N, Mytas D Z, Pyrgakis V N. The changing faces of aortic dissection: an unusual presentation mimicking pulmonary embolism[J]. Heart, 2007, 93(11):1324.PMCID: PMC2016943 DOI: 10.1136/hrt.2006.104414 [12]Shrivastava S, Uppin S G, Arora A J. Pulmonary artery intimal sarcoma mimicking pulmonary thromboembolism in a known case of urothelial carcinoma: a case report[J]. Indian Journal of Thoracic & Cardiovascular Surgery, 2015, 31(3):242-245. |
|
|
