35岁男性,间歇呼吸困难1周,活动后加剧
Posterior-anteriorchestradiographGreenarrow:rightlowerlobe,peripheral,wedge-shaped,airspaceopacity,concerningforHampton’shumpBluearrow:rightmiddlelobeincreasedlucency,implyingregionaloligemia(Westermarksign).Orangearrow:dilatationoftherightpulmonaryarterywithabruptcutoff(blackarrow),concerningforFleischnerandknucklesigns,respectively.Orangearrows:CoronalCTangiographydemonstratingdilatedpulmonaryarteries(Fleischnersign)withabruptvesselcutoffoftherightlowerlobepulmonaryartery(knucklesign;bluearrow),correspondingtofindingsinchestradiograph.Orangearrow:AxialCTangiographyofthechestatthelevelofthepulmonaryarterybifurcation,demonstratingasaddlethromboembolism.Diagnosis:Pulmonaryembolism(PE)PEcanoccurwithoutaknowncauseorasaresultofnumerousprothromboticconditions.Delayedmorbiditymayoccurebyrecurrentpulmonaryembolism(8%infirstyear)orchronicpulmonaryhypertension(4%at2years).Theabovecasedemonstratesmultiplerarebutspecficradiographicfindingsofpulmonaryembolism.TheseincludetheWestermark,knuckle,Fleischnersigns,inadditiontoHamptonshump.
TheWestermarksignisshownintherightmiddleandinferiorlungfieldsasaregionofrelativehyperlucencyresultingfromoligemiadistaltotheclot.Theknucklesignisanabruptcutoffofthepulmonaryartery,asshownbytheblackarrowinchestX-rayandconfirmedbythebluearrowinCTA.TheFleischnersignreferstoanenlargedcentralpulmonaryarteryproximaltotheclot.TheclassicHampton’shumpiswelldemonstratedattherightcostophrenicangle.
Thepatientreceivedimmediateanticoagulationandasingledoseofalteplase,resultinginsignificantclinicalimprovementduringthesubsequent24h.▼更多精彩推荐，
