胸痛的诊断和鉴别诊断.pptVIP

**FIGURE8-5AA,Techniqueforevaluatingthecarotidarterypulsations.B,Techniquefortimingpulsesinthefemoralandradialarteries.C,Techniqueforpalpationofthedorsalispedisarteries.D,Techniqueforpalpationoftheposteriortibialarteries.(FromSwartzMH[ed]:TextbookofPhysicalDiagnosis:HistoryandExamination.3rded.Philadelphia,WBSaunders,1998,pp300,329,and330.)**FIGURE53-19Computedtomography(CT)fordiagnosingaorticdissection.Shownisacontrast-enhancedspiralCTscanofthechestatthelevelofthepulmonaryarteryshowinganintimalflap(I)inthedescendingthoracicaortaseparatingthetwoluminainatypeBaorticdissection.F=falselumen;T=truelumen.**TABLE66-3MostCommonSymptomsandSignsAmongthe2454PatientsintheInternationalCooperativePulmonaryEmbolismRegistry(ICOPER)**FIGURE66-5Electrocardiogramfroma33-year-oldmanwhopresentedwithaleftmainpulmonaryarteryembolismonchestcomputedtomographicscan.Hewashemodynamicallystableandhadnormalrightventricularfunctiononechocardiogram.Histroponinandbrainnatriureticpeptidelevelswerenormal.Hewasmanagedwithanticoagulationalone.Ontheinitialelectrocardiogram,hehasaheartrateof90perminute,S1Q3T3,andincompleterightbundlebranchblock,withinvertedorflattenedTwavesinLeadsV1throughV4.**FIGURE66-6Posteroanteriorchestfilmofapatientwithpulmonaryembolismshowsa“Hampton’shump”intherightlowerlungfield,ahomogeneous,wedge-shapeddensityintheperipheralfield,convextothehilum.(CourtesyofDr.JackL.Westcott,TheNewYorkHospitalandCornellUniversityMedicalCollege.)**TABLE66-7EchocardiographicSignsofPulmonaryEmbolism**FIGURE66-17AA77-year-oldwomanhadright-sidedheartfailuredespite3daysoffull-doseheparin.Therefore,sheunderwentrightheartcatheterizationandpulmonaryangiography.Herpulmonaryarterialpressurewas55/30mm