小腿肌间静脉血栓形成并急性肺血栓栓塞症延迟诊治分析  

Analysis of Delayed Diagnosis and Treatment of Msucular Calf Vein Thrombosis with Acute Pulmonary Thromboembolism

作　　者：贾卫红 王丽娜[1] 蒋洋洋 杨栋才 卜丽娜 刘志燕 刘雅东 唐晶晶 JIA Weihong;WANG Lina;JIANG Yangyang;YANG Dongcai;BO Lina;LIU Zhiyan;LIU Yadong;TANG Jingjing(Department of Respiratory and Critical Care Medicine,the Affiliated Hospital of Northwest University,Xi'an 710083,China;Department of Emergency,Xi'an No.3 Hospital,the Affiliated Hospital of Northwest University,Xi'an 710083,China)

机构地区：[1]西北大学附属医院西安市第三医院呼吸与危重症医学科,西安710083 [2]西北大学附属医院西安市第三医院急诊科,西安710083

出　　处：《临床误诊误治》2025年第5期16-19,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨小腿肌间静脉血栓形成(MCVT)并急性肺血栓栓塞症的临床特点,以避免延迟诊治。方法回顾分析2019年1月至2023年12月收治的7例MCVT并急性肺血栓栓塞症的临床资料。结果7例中男3例、女4例,年龄均≥60岁,均存在误诊。临床表现:发热1例,晕厥1例,气短6例,胸闷6例。7例D-二聚体、纤维蛋白降解产物均升高。MCVT部位:双侧2例,左侧4例,右侧1例;肺血栓栓塞症部位:双侧肺动脉主干2例,右肺动脉3例,左肺动脉2例。7例均存在多发肺动脉栓塞。误诊为急性冠状动脉综合征2例、肺部感染5例,误诊时间7 d~3个月。7例给予利伐沙班抗凝治疗,1例停抗凝药再次出现肺血栓栓塞症,目前正在接受抗凝治疗,余6例已治愈。结论MCVT并急性肺血栓栓塞症早期症状轻,容易出现误漏诊,须提高对该合并症的认知。MCVT患者如果出现突发的胸闷、气短及晕厥,尤其是有肿瘤、心房颤动史者,须高度警惕合并肺血栓栓塞症的可能。Objective To investigate the clinical characteristics of muscular calf vein thrombosis(MCVT)complicated with acute pulmonary thromboembolism(APTE),so as to avoid the delay in diagnosis and treatment.Methods The clinical data of 7 patients with MCVT and APTE treated from January 2019 to December 2023 were retrospectively analyzed.Results Among the 7 patients,there were 3 males and 4 females aged≥60 years,and all patients were misdiagnosed.Clinical manifestations revealed fever in 1 patient,syncope in 1 patient,shortness of breath in 6 patients,and chest tightness in 6 patients.D-dimer and fibrin degradation products were increased in 7 patients.The sites of MCVT were bilateral in 2 patients,left in 4 patients and right in 1 patient.Site of pulmonary thromboembolism included bilateral main pulmonary artery in 2 patients,right pulmonary artery in 3 patients,and left pulmonary artery in 2 patients.All 7 patients had multiple pulmonary embolism.The patients were misdiagnosed with acute coronary syndrome in 2 patients and pulmonary infection in 5 patients,and the misdiagnosis lasted 7d-3 months.Seven patients were treated with anticoagulant therapy with Rivaroxaban,1 patient had recurred pulmonary thromboembolism after withdrawal of anticoagulant therapy,and was treated with anticoagulant therapy,and the remaining 6 patients were cured.Conclusion The early symptoms of MCVT complicated with APTE are mild and more likely to be missed.We need to improve the understanding of this complication.Patients with MCVT who have sudden chest tightness,shortness of breath and syncope,especially those with a history of tumor and atrial fibrillation,should be highly suspected of the possibility of developing pulmonary thromboembolism.

关 键 词：肌间静脉血栓形成 下肢 肺血栓栓塞症 误诊 肺部感染 CT肺动脉造影 

分 类 号：R563.5[医药卫生—呼吸系统]