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NEJM:自发性咽后血肿-案例报道

2016-01-21 MedSci MedSci原创

http://www.nejm.org/doi/full/10.1056/NEJMicm1505596

男性,56岁,因咽喉肿痛、呼吸困难、仰卧位时伴有加重而到急诊室求诊。在出现这些症状前,其无外伤史。



经问诊,该男子既往有前列腺癌、高血压、高脂血症、深静脉血栓形成和中风病史。曾应用过的药物包括:华法林、抗高血压药和他汀类药物。
常规体格检查发现,其后口咽部有显著的轻微肿胀并伴有发热。

实验室检查显示白细胞计数正常,凝血酶原时间为120s和活化部分凝血活酶时间为127s。
颈部的X线片显示软组织肿胀,压迫气道(如图A所示);在随后的颈部CT扫描检查中的显示的结果与X线片检查结果一致。会诊医师猜测着可能是应用抗凝药物引起的血肿(图B显示矢状位、图C为轴视图;箭头所指为血肿处)。

鼻喉镜检查发现后咽部肿胀但气道仍通畅。最后,会诊医师决定对该男子申请输注6U的新鲜冰冻血浆进行治疗,并随后送往ICU接受进一步的治疗和观察。

4天后,该男子的凝血功能障碍得到解决,症状减缓,顺利康复出院。

原始出处:

Ditkofsky N, Hanna T.Spontaneous Retropharyngeal Hematoma.  N Engl J Med. 2016 Jan 21;374(3):e3.

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    2017-01-02 1e1d41dem97(暂无匿称)

    很好的病例

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=167571, encodeId=865816e5711b, content=很好的病例, beContent=null, objectType=article, channel=null, level=null, likeNumber=128, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dcdc2004057, createdName=1e1d41dem97(暂无匿称), createdTime=Mon Jan 02 23:14:34 CST 2017, time=2017-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=133820, encodeId=d2d11338202c, content=赞一个!好文章拜读了,认真学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Fri Sep 23 20:07:00 CST 2016, time=2016-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=61161, encodeId=ec9161161c8, content=罕见, beContent=null, objectType=article, channel=null, level=null, likeNumber=155, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Wed Jan 27 18:58:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=61162, encodeId=d82b61162e9, content=长见识, beContent=null, objectType=article, channel=null, level=null, likeNumber=164, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Wed Jan 27 18:58:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1394901, encodeId=86b51394901a0, content=<a href='/topic/show?id=be548989e09' target=_blank style='color:#2F92EE;'>#血肿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89897, encryptionId=be548989e09, topicName=血肿)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=85df2500173, createdName=654699882_84926986, createdTime=Fri Jan 22 21:16:00 CST 2016, time=2016-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1530527, encodeId=f686153052e1b, content=<a href='/topic/show?id=ed4a860e872' target=_blank style='color:#2F92EE;'>#自发性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86078, encryptionId=ed4a860e872, topicName=自发性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=584a12117168, createdName=sodoo, createdTime=Fri Jan 22 21:16:00 CST 2016, time=2016-01-22, status=1, ipAttribution=)]
    2016-09-23 ylzr123

    赞一个!好文章拜读了,认真学习了。

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=167571, encodeId=865816e5711b, content=很好的病例, beContent=null, objectType=article, channel=null, level=null, likeNumber=128, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dcdc2004057, createdName=1e1d41dem97(暂无匿称), createdTime=Mon Jan 02 23:14:34 CST 2017, time=2017-01-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=133820, encodeId=d2d11338202c, content=赞一个!好文章拜读了,认真学习了。, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Fri Sep 23 20:07:00 CST 2016, time=2016-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=61161, encodeId=ec9161161c8, content=罕见, beContent=null, objectType=article, channel=null, level=null, likeNumber=155, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Wed Jan 27 18:58:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=61162, encodeId=d82b61162e9, content=长见识, beContent=null, objectType=article, channel=null, level=null, likeNumber=164, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=240a1683959, createdName=李继凯, createdTime=Wed Jan 27 18:58:00 CST 2016, time=2016-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1394901, encodeId=86b51394901a0, content=<a href='/topic/show?id=be548989e09' target=_blank style='color:#2F92EE;'>#血肿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=89897, encryptionId=be548989e09, topicName=血肿)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=85df2500173, createdName=654699882_84926986, createdTime=Fri Jan 22 21:16:00 CST 2016, time=2016-01-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1530527, encodeId=f686153052e1b, content=<a href='/topic/show?id=ed4a860e872' target=_blank style='color:#2F92EE;'>#自发性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=86, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=86078, encryptionId=ed4a860e872, topicName=自发性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=584a12117168, createdName=sodoo, createdTime=Fri Jan 22 21:16:00 CST 2016, time=2016-01-22, status=1, ipAttribution=)]
    2016-01-27 李继凯

    罕见

    0

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    2016-01-27 李继凯

    长见识

    0

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    2016-01-22 sodoo

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