高龄老年人自发性乳糜胸误诊为慢性心力衰竭原因分析  

A Discussion of Spontaneous Chylothorax in Senile Patients Misdiagnosed as Chronic Heart Failure

作　　者：范光德 梅周芳[1] 黄琦慧 钱凌[1] 都勇[1] 施劲东[1] 揭志军[1] 

机构地区：[1]复旦大学附属上海市第五人民医院呼吸内科,上海200240

出　　处：《临床误诊误治》2015年第7期9-12,共4页Clinical Misdiagnosis & Mistherapy

基　　金：上海市闵行区科学研究课题(2012MHZ019);上海市科委自然基金生物引导类项目(134119b1200);上海市卫生系统优秀学科带头人(XBR2013078)

摘　　要：目的探讨自发性乳糜胸误诊误治原因,提高临床医师对该病的诊治水平。方法对我院收治的1例自发性乳糜胸误诊病例资料进行回顾性分析,并复习相关文献。结果患者81岁,因活动时气促伴双足水肿20 d入院。外院诊断为慢性心力衰竭、胸腔积液,行利尿、强心治疗后,患者症状加重。转我院后心脏超声未见明显异常,胸部CT检查示右侧胸腔积液伴右肺下叶膨胀不全。诊断性胸腔穿刺胸腔积液检查示外观呈乳糜样,培养无细菌生长,苏丹Ⅲ染色阳性。完善检查排除相关疾病后确诊为自发性乳糜胸。经多次右侧胸膜腔封闭术,复查胸部CT示胸腔积液消失,随访8个月未见复发。结论胸腔积液患者行诊断性胸腔穿刺胸腔积液检查,对其病因诊断至关重要;胸腔积液苏丹Ⅲ染色有助于鉴别真性和假性乳糜胸。Objective To analyze the cause of misdiagnosis of spontaneous chylothorax to improve treatment of this disease. Methods A ease of spontaneous chylothorax of our hospital was retrospectively analyzed, with a review of literature. Results Upon admission, the 81-year-old female patient, who had been diagnosed as chronic heart failure and pieural effu- sion in a local hospital, complained of dyspnea on exertion and foot edema for more than 20 days. After taking diuretics and cardiotonic drugs, her condition became worse, and then she was transferred to our hospital. The heart structure and function were not obviously abnormal on echocardiography. The chest CT scan showed right pleural effusion, with incomplete expansion in the lower lobe of the right lung. The pleural effusion was found to be chyliform after thoracentesis. The examination of pleu- ral effusion showed that the bacterial culture was negative and the dyeing with Sudan Ⅲ was positive. After other relevant dis- eases were excluded, the spontaneous chylothorax was diagnosed. Therefore, the patient was treated with pleural closure for 5 times using lidocaine 0.2 g, lentinan 3 mg, dexamethasone 5 mg and normal saline 20 ml. The chest CT scan showed that the pleural effusion subsided. During eight months of follow-up, there was no relapse of chylothorax. Conclusion For patients with plcural effusion, particularly associated with a variety of complications, a diagnostic thoracentesis should be performed. The examination of hydrothorax is necessary for confirming the cause of the disease. The dyeing with Sudan Ⅲ for pleural effu- sion is helpful to identify the real chylothorax.

关 键 词：乳糜胸 胸腔积液 误诊 心力衰竭 香菇多糖 

分 类 号：R561.7[医药卫生—呼吸系统]