鉴别诊断Pohost 医师:患者为男性,59岁。入院前10个月突然发生左心衰竭,随后左心和右心衰竭日益加剧。患者除心脏病外,尚罹患肺部疾患。入院时的检查发现还提示中枢神经系统疾病。头两次住院期间,也许由于静息时呼吸困难的发生,显然怀疑肺疾患是发病起作用因素,详细资料很少。然而,肺活检仅显示轻度肺纤维化,可能与过去大量吸烟有关。鉴于患者曾在拉丁美洲广泛旅行,需要考虑霉菌疾病,如肺芽生菌病。仍是,由于肺门或其余肺部没有受累,因而霉菌疾病的可能性极小。肺部疾患的其他证据,包括肺动脉压和动脉氧饱和度较高,非常符合左心衰竭和肺充血。 Differential Diagnosis Dr. Pohost: The patient is male, 59 years old. Left heart failure occurred suddenly 10 months before admission, followed by an increasing exacerbation of left and right heart failure. In addition to heart disease patients, still suffering from lung disease. Examination at admission also revealed CNS disease. During the first two hospitalizations, perhaps due to dyspnea at rest, it is clear that lung disease is a contributing factor in the pathogenesis, with very little detail. However, lung biopsies show only mild pulmonary fibrosis and may be related to past smoking in large quantities. Given that patients have traveled extensively in Latin America, there is a need to consider mold diseases such as pulmonary budding disease. Still, the fungal disease is less likely due to the absence of the hilar or the rest of the lungs. Other evidence of lung disease, including higher pulmonary arterial pressure and arterial oxygen saturation, is in good agreement with left ventricular failure and pulmonary congestion.