急性二尖瓣脱垂致右侧为主的肺水肿1例  

Acute mitral regurgitation causing right-sided pulmonary edema:a case report

作　　者：曹宇 王亚齐 路昕 韩业晨[4] 范俊平[2] 苏龙翔 Cao Yu;Wang Yaqi;Lu Xin;Han Yechen;Fan Junping;Su Longxiang(Department of Internal Medicine,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Pulmonary and Critical Care Medicine,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Emergency Medicine,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Cardiology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Intensive Care Unit,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院内科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院呼吸与危重症医学科,北京100730 [3]中国医学科学院北京协和医学院北京协和医院急诊科,北京100730 [4]中国医学科学院北京协和医学院北京协和医院心内科,北京100730 [5]中国医学科学院北京协和医学院北京协和医院重症医学科,北京100730

出　　处：《中华结核和呼吸杂志》2024年第12期1148-1150,共3页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：中国医学科学院医学与健康科技创新工程项目(2023-I2M-CT-B-031);中央高水平医院临床研究基金(2022-PUMCH-B-108)。

摘　　要：患者青年女性,因突发胸闷、不能平卧来诊,以迅速进展的呼吸衰竭及心源性休克为主要临床特点,结合心脏超声结果,考虑病因为乳头肌断裂、急性二尖瓣脱垂,患者CT表现为独特的右侧为主的肺水肿,该CT表现对重度二尖瓣关闭不全有较高的诊断特异性。经过瓣膜置换、呼吸循环支持、抗心力衰竭治疗后,肺部阴影明显改善。结合急性左心力衰竭的临床症状、独特的右侧为主的肺水肿CT表现,及时想到重度二尖瓣关闭不全的诊断,尽早针对病因进行治疗,对改善患者预后有重要的意义。A young female presented to our emergency department with sudden-onset shortness of breath and orthopnea.Her condition rapidly worsened.She developed severe respiratory failure and cardiogenic shock ensued.Noticeably,the patient's CT scan showed a unique pattern of right-sided unilateral pulmonary edema,a feature highly specific for severe mitral regurgitation.Echocardiography confirmed papillary muscle rupture and acute mitral valve prolapse to be the cause.Her condition improved significantly after mitral valve replacement and with respiratory and circulatory support,as well as with other heart failure treatment.The classic symptoms of acute left heart failure combined with the unique CT manifestation of predominantly right-sided pulmonary edema suggested severe mitral regurgitation.Prompt diagnosis and early initiation of treatment aimed at the underlying cause is of great significance in improving the patient's prognosis.

关 键 词：二尖瓣脱垂 心源性休克 肺部阴影 主要临床特点 瓣膜置换 呼吸循环 诊断特异性 心脏超声 

分 类 号：R542.51[医药卫生—心血管疾病] R541.63[医药卫生—内科学]