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Pulmonary infarction

Disease name

Pulmonary infarction Yes pulmonary embolism Lung caused by blood flow blockage Tissue necrosis , common causes of pulmonary embolism Embolus yes Deep vein thrombosis 。 The clinical manifestations are chest tightness, shortness of breath dyspnea 、 Chest pain 、 Low fever 、 Hemoptysis 。 It comes on suddenly and violently, and its condition is critical, mortality High, but it is often misdiagnosed as pneumonia 、 pleurisy , pulmonary edema Atelectasis And shall be identified with it. Accurate diagnosis and active treatment, such as immediate thrombolysis, thrombolysis or anticoagulation, can cure pulmonary infarction.

catalog

one brief introduction
two Pathogenesis
three clinical manifestation
▪ Sudden chest tightness, shortness of breath and dyspnea

six prevention
seven Typical case

brief introduction

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pulmonary embolism It is a common disease, pulmonary embolism It is a pulmonary circulation disorder disease that occurs after the pulmonary artery branch is blocked by an embolus. Pulmonary infarction Yes pulmonary embolism Later, pulmonary tissue necrosis occurred due to blood flow blockage.

Pulmonary infarction is not uncommon, about 10-15% pulmonary embolism In case of pulmonary infarction, it is sudden, fierce and critical, mortality High, but the clinical manifestations are complicated due to secondary diseases Imaging The performance and lack of understanding can easily lead to clinical misdiagnosis or imaging misdiagnosis. Incorrect diagnosis directly affects patients and increases their financial burden. Timely and accurate diagnosis is the key to treatment.

Pathogenesis

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Pulmonary infarction

Because the lung tissue is supplied by both bronchial artery and pulmonary artery, only a few embolisms cause tissue ischemia and necrosis, resulting in infarction. Pulmonary infarction is the lung caused by blood flow blockage after pulmonary embolism Tissue necrosis , common causes of pulmonary embolism Embolus yes Deep vein thrombosis 。

The main source of thrombus is Deep veins of lower limbs 80%~90%, followed by pelvic cavity prostate Venous and cardiac disorders. Long illness in bed, pregnancy Major operation After and Cardiac insufficiency Occurring Deep vein thrombosis , is happening pulmonary embolism Cause of disease.

rheumatic heart disease Thrombosis and its primary origin pulmonary artery Thrombosis is also the cause of this disease. The embolus entering the pulmonary circulation may also contain fat tumour Embolus and gas, etc.

pulmonary embolism The pathological changes of the lung depend on the size of the embolus and the state of pulmonary blood circulation.

The size of emboli varies from small emboli in microvessels to straddling thrombus in great arteries. It is not easy to cause blood circulation disorder when smaller emboli fail to completely block blood vessels. Multiple small emboli can cause multiple arteriole Branch embolism, which can be caused by blocking the main or large branches of the pulmonary artery with large emboli Acute right heart failure To death. serious Pulmonary congestion Patient's pulmonary embolism May cause pulmonary infarction.

Pulmonary infarction is common in the lower lobe, which is conical in shape and pointed to the tip Hilum of lung 。 The center of the lesion is necrotic area with edema and hemorrhage around. Edema and hemorrhage can be absorbed, and fibrosis occurs after the necrosis area is healed.

clinical manifestation

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The patient has an acute onset dyspnea ， Chest pain and Hemoptysis 。 hemoptysis It indicates that there is pulmonary infarction. single shot The embolic symptoms of small branches of pulmonary artery Major embolism, or extensive embolism with small branches dyspnea 、 Cyanosis 。 The lungs can be smelled dry or wet by auscultation Rale 。 Precordial region Noise and abnormal heart rate can be heard. acute pulmonary embolism About 10% of the patients died within 1 hour of onset. If diagnosis and treatment are not made in time, about 30% of patients suffer from pulmonary embolism Recurrence and death. Patients often have chronic heart disease, recent surgery, history of trauma, thromboocclusive disease Phlebitis Pregnancy, long-term bed rest Hyperviscosity And other inducements.

Sudden chest tightness, shortness of breath and dyspnea

Since the onset of the disease, patients often cannot lie on their back, Sitting upright breathing , difficult to sleep. This is part of the lung tissue after infarction, Lung ventilation Deficiency, Hypoxemia and Chest pain Not able to breathe deeply and other factors.

Chest pain

Chest pain It is another prominent clinical feature. Sudden chest pain is pleura pain. The patient often dare not breathe deeply, cannot lie on the side of the patient, or even cannot fall asleep. This is because the visceral pleura is supplied by the lungs, and the visceral pleura is edematous and necrotic after infarction.

Low fever

The body temperature was normal at the onset of the disease, and then gradually increased, mostly at 38 ℃~38 Between 5 ℃, it drops to normal in about 1 week, which is lung tissue ischemia Necrosis. Prominent clinical symptoms, increasing respiratory pulse and Low fever This is another clinical feature of this disease, which is different from the general Infectivity Disease.

Hemoptysis

More patients than the first 2-3 days after onset Hemoptysis , from bloody sputum to cough Purplish black clot It lasts for about 3 to 33 days, most of which lasts for 10 to 15 days. Hemoptysis Long duration is another characteristic of this disease.

Auxiliary diagnosis

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pulmonary embolism Can be controlled by ordinary X-ray plain film 、 Angiography CT, MR and nuclide scanning.

Single pulmonary artery branch pulmonary embolism X-ray can show no abnormal manifestations. X-ray can show abnormal manifestations of large branches and multiple small branches embolism.

(1) Lung ischemia: when Lobar lung or Pulmonary segment Arterial embolism The corresponding range of lung markings decreases or disappears, and the transparency increases, which is called Westmark sign. Small multiple Arterial embolism cause Universality Lung ischemia.

(2) Pulmonary artery abnormality: the diseased pulmonary artery is thickened due to thrombosis and impaction, and its distal end is thinner due to decreased blood flow. SCT display is clear

(3) Reduced lung volume: Inferior lobe pulmonary embolism It is more common, so lung volume reduction is also common in the lower lobe, causing the diaphragm to rise, and the hilar and interlobar fissure to move downward. And can be combined in disc shape Atelectasis 。

（4） Cardiac enlargement : enlargement of heart shadow Right ventricle It is caused by enlargement and can be seen in embolism or multiple cases of larger pulmonary artery pulmonary embolism .

X-ray, SCT and MRI It can be made clear

Angiography Nuclide scanning can also help diagnosis

D-dimer Negative can exclude acute PTE , positive is not a special test for PTE

differential diagnosis

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This disease is often misdiagnosed as pneumonia , pleurisy, pulmonary edema Atelectasis And shall be identified with it.

pneumonia Patient first have a fever , the symptoms of systemic poisoning are obvious, and the temperature, pulse and respiration rise synchronously, Chest pain Light, rust colored sputum with short duration, fast absorption after treatment, no acute pulmonary heart disease , None Hilar truncation sign , different from pulmonary infarction. No cone in the lung of pleurisy Real change , None Hemoptysis symptom. Pulmonary edema is mostly bilateral, without severe Chest pain , None Hilum of lung Truncation and cone consolidation, which is different from pulmonary infarction, can be absorbed quickly after treatment.

Since pulmonary infarction mostly occurs in patients with heart and lung diseases Chest radiograph See above at the same time pulmonary heart disease 、 Pulmonary congestion And pulmonary edema sign The possibility of lung consolidation turning into pulmonary infarction should be considered. In patients without cardiopulmonary disease, pulmonary infarction can cause Pulmonary hemorrhage Without pulmonary infarction, and pulmonary hemorrhage X-ray It is not easy to distinguish from pulmonary infarction. If there are no other obvious changes in the heart and lung, it may indicate that there is a high possibility of pulmonary hemorrhage. Simple pulmonary hemorrhage can completely disappear in 7-10 days or less without residual traces. The regression of pulmonary infarction is relatively slow, taking about 20 days on average, up to 5 weeks. Most cases can have residual fibers scar The cord like shadow of.

prevention

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Pulmonary infarction

More than half of the emboli that damage the lungs are from Lower limb veins 。 In addition, pelvic cavity Iliac vein 、 right atrium The embolus in the can also cause pulmonary infarction. Therefore, if there is deep phlebitis of lower limbs fracture , delivery, operation or heart atrial fibrillation Patients with medical history, etc pneumonia We should go to the hospital immediately for early diagnosis and active treatment, such as immediate thrombolysis, thrombolysis or anticoagulation. Pulmonary infarction can be cured.

Geriatric viscosity of blood High, slow blood flow, lower limb trauma, especially after fracture, will cause Vascular wall Unsmooth. If you stay in bed for a long time after the operation, it is easy to form thrombosis in the lower limbs or pelvic cavity, and the embolus falling off may lead to pulmonary infarction. Therefore, patients with fracture, especially those with lower limb fracture, receive surgical treatment The elderly patients should get up early after the operation. Patients who need to stay in bed for a long time can often take deep breath and move their lower limbs in bed (or with the help of family members) to prevent Venous embolism Formation. For patients with a definite diagnosis of lower limb venous embolism, the embolus in the body is like Time bomb Similarly, it may fall off at any time and cause pulmonary infarction. Therefore, in addition to active treatment, patients should always change their positions and not sit still for a long time to avoid pulmonary infarction.

Typical case

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1. A 73 year old Uncle Wang sat cross legged and played mahjong all afternoon. When he stood up, he suddenly felt sharp pain in his left chest, Exhalation Even worse, I dare not breathe. Uncle Wang didn't care until he vomited several mouthfuls of blood two days later and went to the hospital for treatment. Through the lungs CT 、 Pulmonary arteriography The doctor confirmed that Pulmonary thromboembolism 。 Uncle Wang developed leg swelling three days after hospitalization. Doppler ultrasound showed that there was embolism in the deep vein of the left lower limb. It turns out that the pulmonary infarction detected three days ago is Venous thrombosis of lower limb Falling off.

2. Professor Zhang, 77, fell down carelessly while walking, resulting in the left lower limb Femoral neck fracture , stayed in bed for several months. One day, a nurse was talking with Professor Zhang while massaging his lower limbs. Professor Zhang suddenly had chest tightness and shortness of breath, and died after rescue. At first, doctors thought that Professor Zhang died of myocardial infarction, but after autopsy, they found that the old professor died of pulmonary infarction, and the emboli that damaged the lungs were caused by the lack of exercise for a long time after the fracture of the lower limbs.

3. Bayi Women's Basketball Player Wang Fan He died of pulmonary infarction on February 15, 2010 at the age of 26. Wang Fan played against the women's basketball team on January 24 Beijing She fainted suddenly during the training before the women's basketball team. According to team-mates, "the team was just warming up, and there was not much Amount of exercise Wang Fan suddenly fainted. " After emergency rescue, Wang Fan woke up. But after entering the hospital, Wang Fan just went to the bathroom once and fell into a coma. Until February 15, Wang Fan left the world. After the death of Comrade Wang Fan WCBA The General Political Department of the People's Liberation Army approved Wang Fan as a "revolutionary martyr" for the actual situation and peacetime performance of sacrifice in the competition.

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