每日一题_2024.12.29

A 90-year-old man with atrial fibrillation and dementia presented to the hospital with sudden onset of dyspnea that had begun 1 hour earlier. Before admission, he had not been taking anticoagulation therapy on the basis of discussions of his preferences with his primary care physician. Physical examination was notable for tachypnea and tachycardia. On chest radiography, the pulmonary vasculature was not visible in the right lung fields. In addition, the right descending pulmonary artery was enlarged. What diagnosis is suggested by these chest radiograph appearances?

一位90岁的男性，患有房颤和痴呆，因1小时前突然发作的呼吸困难被送至医院。在入院前，他根据与主治医生就他的偏好进行的讨论，没有接受抗凝治疗。体格检查显示呼吸急促和心动过速。胸部X光片显示右肺野肺血管不可见。此外，右下肺动脉增大。这些胸部X光表现提示的诊断是什么？

A. Ascending Aortic Aneurysm升主动脉瘤

B. Atrial septal defect房间隔缺损

C. Bullous emphysema大疱性肺气肿

D. Pulmonary embolism肺栓塞

E. Pulmonary arterial hypertension肺动脉高压

答案解析：

这些X光片发现显示了Westermark征，这表明在肺栓塞远端有一个血流减少的区域，以及Palla征，即右下肺动脉的扩大。胸部计算机断层扫描（CT）肺血管造影证实了两个肺动脉中存在肺栓塞，主要在右侧。CT扫描还显示了右侧肺实质中的血流减少。

正确答案：D