目的 探讨呼吸困难症状在肺栓塞鉴别诊断中的价值.方法 对临床少见气胸并肺栓塞1例的临床资料进行回顾性分析并复习相关文献.结果 本例因活动后胸闷、气短3d入院,曾在当地镇医院就诊,按右侧气胸治疗症状未见好转,入我院.因气胸诊断明确予胸腔闭式引流,肺复张后仍有胸闷、气短.行相关检查排除心力衰竭、支气管哮喘等可引起呼吸困难的疾病,查D-二聚体增高,CT肺动脉造影检查示两下肺片状不张,下肢彩色多普勒超声检查示下肢肌间静脉血栓,依据临床表现及以上医技检查结果 诊断肺栓塞并下肢深静脉血栓形成,予抗凝治疗后病情好转,出院.结论 呼吸困难是肺栓塞最常见的症状,特异性差.对低危人群通过鉴别呼吸困难病因并保持高度警惕性有助于肺栓塞的及早诊断.%Objective To discuss the value of dyspnea in the diagnosis of pulmonary embolism. Methods Clinical data of one rare case of pneumothorax with pulmonary embolism was retrospectively analyzed in our hospital, and the relevant literature was reviewed. Results The patient, who had been previously diagnosed as right-sided pneumothorax by the local town clinic for chest tightness and shortness of breath for 3 days, was admitted to our hospital and given a treatment of chest drain. But following a full re-expansion, he still had tachypnoea. Further examinations produced a negative result for diseases leading to dyspnea, such as heart failure and bronchial asthma. Meanwhile, the D-dimer test report showed elevated values, computed tomographic pulmonary angiography demonstrated bilateral patchy atelectasis in the lower lobes and color Doppler disclosed thrombi in medial gastrocnemius veins. Therefore, the patient was confirmed as having pulmonary embolism with deep vein thrombosis of the lower limbs according to his clinical features. After anticoagulant therapy, the patient's condition was improved and he was discharged from the hospital. Conclusion Dyspnea is the most common symptom of pulmonary em-bolism, characterized by suddenness and nonspecificity. Careful identification and high alert to pathogeny of dyspnea are con-ducive to the early differential diagnosis of pulmonary embolism in lowrisk population.
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