小腿肌肉血肿误诊为深静脉血栓原因及临床异同分析  

The Identification and Analysis of the Reason for Shank Intramuscular Hematoma Misdiagnosed as deep vein Thrombosis

作　　者：李晨[1] 王秀平[1] 张岩[1] 刘建[1] 王彬[1] 

机构地区：[1]徐州市第一人民医院介入与血管外科,徐州221000

出　　处：《血栓与止血学》2016年第3期279-282,共4页Chinese Journal of Thrombosis and Hemostasis

摘　　要：目的分析小腿肌肉血肿误诊为深静脉血栓(deep vein thrombosis,DVT)的原因,探讨小腿肌肉血肿和DVT临床鉴别方法。方法 2011年1月至2014年4月收治22例小腿DVT和7例小腿肌肉血肿,回顾性分析二者临床症状、体征、实验室检查、影像学检查及治疗的结果。结果 22例DVT中20例临床表现以肿胀为主,疼痛和活动受限程度较轻,为先肿后疼,经抗凝或/和溶栓治疗后19例症状很快得到缓解或消失;7例肌肉血肿则均以疼痛和活动受限为主诉,为先疼后肿,其中4例出现皮肤瘀斑,5例误诊为DVT的肌肉血肿经抗凝或/溶栓治疗后1例症状无缓解、4例症状出现加重,进一步行CT或超声检查明确了血肿诊断,改为止血、穿刺抽吸、改善微循环、理疗等治疗后症状逐渐缓解或消失。结论疼痛和肿胀程度及其先后次序是鉴别小腿肌肉血肿和DVT重要的临床特征,结合CT和软组织超声检查可以有效避免肌肉血肿误诊为DVT。Objective To analyze the reason for shank-intramuscular hematoma misdiagnosed as deep vein thrombosis （DVT）, to investigate the identification methods of shank-intramuscular hematoma and DVT. Methods Retrospective analysis 22 patients with DVT and 7 patients with shank-intramuscular hemato- ma from January 2011 to April 2014, analyzing the clinical manifestations, imageological examination and treat- ment effect. Results The main clinical manifestation of 20 patients in 22 cases with DVT was swelling, but pain and restricted movement were not obvious, pain after the swelling. After anticoagulant therapy and （or） thrombolytic therapy, 19 patients＇ symptoms disappeared quickly. The chief Complaint of 7 patients with intra- muscular hematoma was pain and restricted movement, pain before swelling. 4 patients appeared skin ecchymo- sis. 1 patient＇ s symptom did not ease in 5 intramuscular hematoma cases diagnosed as DVT Other 4 patients＇ symptoms aggravated, who were diagnosed as hematoma used by CT or ultrasonic testing,insteaded of hemosta- sis, puncture suction, improving minicirculation and physiotherapy, etc. The above symptoms gradually ease or disappear. Conclusion The importaint clinical features included pain, swelling and the order of symptom, which conduce to identify shank-intramuscular hematoma and DVT. In combination with CT and ultrasonic tes- ting in Soft-tissue, we may effectivly avoid misdiagnosing shank-intramuscular hematoma as DVT.

关 键 词：肌肉血肿 深静脉血栓 误诊 

分 类 号：R543.6[医药卫生—心血管疾病]