临床表现不典型肺栓塞误诊原因探讨OA

Objective To analyze the causes of misdiagnosis of pulmonary embolism with atypical clinical manifesta-tions and to correct the methods of misdiagnosis.Methods The clinical data of 2 patients with misdiagnosed pulmonary em-bolism from August 2019 to October 2022 were retrospectively analyzed.Results A male patient with a history of hyperten-sion and hyperglycemia was admitted to the hospital due to chest tightness and shortness of breath for 15 d.An electrocardio-gram showed myocardial ischemic changes and a preliminary diagnosis of unstable angina pectoris was made.During the treat-ment,chest CT showed patchy high-density shadow in the lung.Pneumonia was diagnosed and antibiotic treatment was given,but the symptoms were not completely relieved.After further CT pulmonary angiography(CTPA)examination,pulmonary em-bolism was diagnosed,and the misdiagnosis lasted 3 d.The patient's condition improved after anticoagulant therapy with low molecular weight heparin.After discharge,anticoagulant therapy was continued,and CTPA showed no obvious abnormality.A female patient was admitted to the hospital due to injuries of the anterior cruciate ligament and medial collateral ligament of the left knee,and presented with chest pain and palpitations on the day of surgery.The initial diagnosis of unstable angina pecto-ris was made and the corresponding treatment was given.However,the patient had high D-dimer(D-D)and low oxygen satu-ration.After reexamination of electrocardiogram and CTPA,the patient was diagnosed with pulmonary embolism,and the mis-diagnosis lasted 10 d.After adjusting anticoagulant therapy,D-D gradually decreased to normal,blood gas analysis indicators improved,and 15 days afterwards,he was transferred back to orthopedics department for continued treatment.Conclusion Pulmonary embolism is more likely to be misdiagnosed due to atypical symptoms or combined with other disea-ses.Clinicians should improve the understanding of pulmonary embolism and comprehensively analyze the patients'symptoms,signs and examination results to avoid misdiagnosis.