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恶性肿瘤所致心包积液者并非少见,近年来有增多趋势,但临床常延误诊断。本文结合2例误诊病例分析,就恶性心包积液的误漏诊原因、临床识别等问题作一探讨。病例摘要例1,女,32岁。因咳嗽、胸闷、气促2月,下肢水肿1月,于1987年12月20日入院。查体:T36.8℃,P120次/分,Bp12/8 kPa。端坐呼吸,奇脉(+)。颈静脉怒张。双下肺叩诊浊音、呼吸音消失。心界向两侧扩大,HR120次/分,律齐,心音遥远。肝肋下4.5cm,质软,触痛明显;腹水征(一)。双下肢轻度凹陷性水肿。胸片示两侧胸腔中量积液,心影扩大,呈烧瓶状。心脏扇扫示
Pericardial effusion caused by malignant tumors is not uncommon, there is an increasing trend in recent years, but the clinical diagnosis is often delayed. In this paper, combined with two cases of misdiagnosed cases, the cause of malignant pericardial effusion misdiagnosis, clinical identification and other issues for a discussion. Case summary 1, female, 32 years old. Due to cough, chest tightness, shortness of breath in February, lower extremity edema in January, was admitted on December 20, 1987. Physical examination: T36.8 ℃, P120 beats / min, Bp12 / 8 kPa. Sitting breathing, odd pulse (+). Jugular vein engorgement. Double lower lung percussion dullness, breath sounds disappear. Heart to expand on both sides, HR120 beats / min, law Qi, distant heart sounds. Liver ribs 4.5cm, soft, tenderness; ascites sign (a). Lower limbs slightly depressed edema. Chest X-ray showed on both sides of the chest fluid volume, heart shadow to expand, was flask-shaped. Heart fan sweep