* For medical professionals reading only,
PVD has a relatively complex cause. In addition to thromboembolic, left heart or lung diseases, the causes of PVD also include vasculitis and autoimmune disease .
At present, the association between vasculitis and autoimmune diseases and PVD is not clear, and the incidence of vasculitis and autoimmune PVD is not high. However, in order to reduce clinical misdiagnosis and improve patient prognosis, patients with vasculitis and autoimmune PVD still need to receive clinical attention.
"Famous Hospital Medical Record Room-2.0 Case Special Session" There is a case of vasculitis and autoimmune PVD. The doctor first diagnosed the patient with pulmonary embolism , but the patient had no typical chest tightness , chest pain , no thrombosis in the lower limbs, and no hereditary thrombosis, which made the doctor once suspected the reliability of the diagnosis of pulmonary embolism.
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Medical record summary
Patient, male, 23 years old, employee; was admitted to the hospital on August 1, 2016 due to "repeated coughing for February".
medical history : 2 months ago, the patient had cough or sputum without cause. The sputum was mostly white and sticky phlegm, no fever, chest pain, hemoptysis, fainting, and no edema of the lower limbs.
2016.7.5, the patient's chest CT in the outer hospital showed that there was patchy effusion in both lungs (Figure 1).
2016.7.19, the patient visited the outpatient clinic of our hospital. The CTA showed pulmonary embolism in both lungs (Figure 2), but no abnormalities were found in the lower limb venous ultrasound. In addition, the complete set of rheumatism and anti-cardiolipin antibodies were negative; the anti-β2 glycoprotein antibodies were slightly higher (actual measured value 26.3R/ml, reference value <20>
2016.7.20, the patient started to take rivaroxaban (20mg qd) to treat pulmonary embolism. After taking rivaroxaban for 5 days, the patient stopped the medication on his own and was admitted to our hospital on August 1, 2016.
Previous history: Denied infectious diseases and chronic diseases, no history of surgical trauma.
personal history : Denied hobbies for tobacco and alcohol, no history of occupational contact; denied family genetic diseases.
treatment and after
admission examination : T 36.5℃ P 99bpm R 19bpm BP 126/75mmHg. He is 179cm tall and weighs 50kg. He is clear and energetic, and has no cyanosis on his lips. The breathing sound of both lungs is clear, and there is no dry and wet rales. The heart rate is 99bpm, the rhythm is uniform, the P2 is not hyperactive, and there is no noise. The abdomen is soft and tender, the liver and spleen are not touched under the ribs, there is no edema between the lower limbs, and no clubbing finger is seen.
Auxiliary examination :
2016.7.5 Chest CT: There are patchy oozing shadows on both lungs.
Figure 1 2016-7-15 Chest CT
2016.7.19 CTA: Pulmonary embolism of both lungs.
Figure 2 2016-7-19 CTA image
2016.8.1 Chest radiograph : multiple oozing shadows in both lungs.
Figure 3 2016-8-1 Chest X-ray
2016.8.4 Pulmonary ventilation perfusion imaging : The ventilation function of both lungs is slightly obstructed, and the blood flow perfusion in the right lung is blocked and does not match ventilation, and pulmonary embolism is considered.
Cardiac ultrasound : There are no obvious abnormalities in the heart structure function during resting state.
CTPA: It indicates that pulmonary aneurysm is accompanied by wall thrombosis (see Figure 4).
Figure 4 CTPA image
pulmonary angiography : Pulmonary aneurysm is visible in the right lung, as shown in Figure 5.
Figure 5 Pulmonary angiography
Admission diagnosis : Pulmonary embolism (atypical).
Clinical doubts : The patient is a young male, without typical chest tightness, chest pain, and thrombosis in the lower limbs. Why does his pulmonary artery show tumor-like dilation? How do you view non-infarcted patches that occur frequently in both lungs in patients? What are the reasons for patients with ESR and CRP?
After the doctor asked about the medical history, the patient claimed that he had a history of repeated oral ulcers for more than 10 years.
See here, do you know the cause of the patient? Is it a simple pulmonary embolism or a complication related to other diseases? Is more than 10 years of history of oral ulcers meaningful for diagnosis?
[Battle of Pulmonary and Heart Defense 2.0 - Case Special]
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