主动脉夹层病历剖析(国外英文资料).docVIP

主动脉夹层病历分析(国外英文资料) 【 case discussion 】 male, 55 years old, fever, chest pain, breath 1 month? The patient is 55 years old. He was admitted to the hospital with fever with chest pain for a month. No obvious cause fever patients a month ago, the highest temperature is 39 ℃, night sweats, fearless, chills, with near xiphoid process like pain, shortness of breath gradually increase after pain relief. The history of hypertension is 12 years and the control is not ideal. The history of coronary heart disease is 8 years. The hospital outpatient service checks blood WBC 6.85 x 10 / L, neutral 0.70, Hb 110 g/L, PLT269 x 10 ^ 9 / L, blood sedimentation 95 mm / 1 h, PPD (+ +), liver and kidney function is normal, normal thyroid function. The X ray chest is shown in figure 1. The heart color the ascending aorta widens, the mild aortic valve closes not all, a large amount of pericardial fluid. Admission examination: 39 ℃ temperature, pulse is 115 times/min, breathing 28 times/min, right upper limb blood pressure 125/75 mm Hg, left upper limb 105/65 mm Hg. There is no jugular venous wrath, the heart is enlarged on both sides, the heart sounds distant, the double lung breath sound, the qi vein (+), the liver and spleen under the ribs, and the two lower limbs have no edema. The elbow vein is 20 cm H2O (1 cm H2O = 0.098 kPa). Admission diagnosis: fever, pericardial accumulation fluid to be checked; Hypertension; Coronary heart disease (CHD) The 3rd day pericardium of pericardial pericardial puncture, the concentric drainage of hemorrhagic pericardium was about 450 ml. Total number of pericardial effusion cells 4.93 * 10 ^ 11 / L, the WBC 3.8 * 10 ^ 8 / L, single-core 0.76, adenosine deaminase (ADA) 27.9 u/L; Antiacid stain (-), the rapid culture of tuberculosis (-). Pathology: there are lymphocytes, neutrophils, and large amounts of red blood cells. The 8th day enhancement CT is shown in figure 2-4. Question: What is the diagnosis? What is the cause of the fever? Released the answer