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1 病例报告 患者男,19岁,学生。体检时诉左胸不适,摄胸片见左下肺野片状密度增高影,上缘较清晰但不光整,左肋膈角消失,报告为左侧胸膜炎。临床即给予抗炎治疗。某日体育课时,患者突感胸闷气促,急送医院治疗。摄胸片见左中下肺野大片密度不均的阴影,内见含气的肠袢,诊断为左膈疝。手术所见:左膈肌大部分为一层纤维膜状结构,肠管通过一裂孔进入胸腔。最后诊断为:左膈肌发育不全并左膈疝形成 2 误诊原因分析 2.1 没有结合临床及病史 患者无畏寒、发热、胸痛等症状,追问病史得知,患者常有左胸不适感,但可自行缓解消失。既往无结核及胸膜炎病史,所以胸膜炎诊断与临床不符。
1 Case Report Patient Male, 19 years old, student. When the chest was complained of chest discomfort, chest X-ray film to see the lower lung density increased film, the upper edge of the more clear but not the whole, the left costal horn disappeared, reported as left pleurisy. Anti-inflammatory treatment is given clinically. A day of physical education, the patient suddenly felt chest tightness, shortness of breath, rapid hospital delivery. Chest radiograph seen in the middle and lower lungs large area of uneven density of the shadow, see the gas in the intestine, diagnosed as left diaphragmatic hernia. Surgical findings: Most of the left diaphragm as a fibrous membrane structure, bowel through a hole into the chest. The final diagnosis as follows: left diaphragmatic hypoplasia and left diaphragmatic hernia formation 2 misdiagnosis analysis 2.1 did not combine clinical and medical history of patients with no chills, fever, chest pain and other symptoms, history of the patient asked that the patient often have left chest discomfort, but self-ease disappear . No past history of tuberculosis and pleurisy, so the diagnosis of pleurisy and clinical discrepancies.