肺癌、上腔静脉血栓致上腔静脉阻塞综合征误诊为血管性水肿2例  

Two cases of superior vena cava syndrome caused by lung cancer and superior vena cava thrombosis misdiagnosed as angioedema

作　　者：房黎亚 于晓静[2] 李兆凤 FANG Liya;YU Xiaojing;LI Zhaofeng(Department of Dermatology,Zaozhuang Municipal Hospital,Shandong,Zaozhuang 277100,China;Department of Dermatology,Qilu Hospital of Shandong University,Shandong,Jinan 250014,China;Department of Dermatology,People’s Hospital of Ningxia Hui Autonomous Region,Ningxia,Yinchuan 750004,China)

机构地区：[1]山东省枣庄市立医院皮肤科,山东枣庄277100 [2]山东大学齐鲁医院皮肤科,山东济南250014 [3]宁夏回族自治区人民医院皮肤科,宁夏银川750004

出　　处：《中国医药科学》2024年第2期189-191,共3页China Medicine And Pharmacy

摘　　要：目的分析上腔静脉阻塞综合征误诊的原因,并探讨皮肤科面部水肿患者的诊疗思路。方法对2例误诊为血管性水肿的上腔静脉阻塞综合征患者进行临床资料描述分析。结果1例以眼睑、面颈部水肿性红斑伴咳嗽、咳痰为临床表现,抗过敏治疗无效,胸部增强CT示右肺门中央型肿瘤,胸腔积液病理示小细胞肺癌,化疗后未再出现面颈部水肿;另1例表现为头面颈、胸背部肿痛,有“脑梗死”家族史,激素等抗炎治疗有效,停药后肿痛加重,颈部增强CT示左侧颈静脉、头臂静脉及上腔静脉血栓形成,抗凝治疗半年后行介入手术,术后头面颈部水肿及胸前静脉曲张完全消退。结论皮肤科首诊此类疾病,因临床思维局限性容易误诊,临床诊疗过程应该开拓思路,必要时行多学科会诊。Objective To analyze the causes of misdiagnosis of superior vena cava syndrome,and to explore the diagnosis and treatment of facial edema in dermatology.Methods The clinical data of 2 patients with superior vena cava syndrome misdiagnosed as angioedema were described and analyzed.Results One patient was clinically manifested with edema erythema of eyelid,face and neck accompanied by cough and expectoration,and the antiallergic treatment was ineffective;chest enhanced CT showed central tumor of right hilum,and pathological examination of pleural effusion showed small cell lung cancer;no edema of face and neck occurred after chemotherapy.Another patient was clinically manifested with swelling and pain in the head,face,neck,chest and back,and had a family history of"cerebral infarction";anti-inflammatory treatment such as hormone was effective,and the swelling and pain became worse after drug discontinuation;the neck enhanced CT showed thrombosis in the left jugular vein,brachiocephalic vein and superior vena cava;interventional operation was performed six months after anticoagulation treatment,and the edema in the head,face and neck and varicose veins in the chest completely resolved after operation.Conclusion Since this is the first diagnosis of this kind of diseases in dermatology department,it is easy to be misdiagnosed due to the limitation of clinical thinking.In the process of clinical diagnosis and treatment,it is supposed to explore new ideas,and conduct multidisciplinary consultation when necessary.

关 键 词：小细胞肺癌 静脉血栓形成 上腔静脉阻塞综合征 血管性水肿 

分 类 号：R543.6[医药卫生—心血管疾病]