medicina48巻4号

2011年04月発行

今月の主題 緊急画像トラブルシューティング―内科医のためのPearlとPitfall 循環器疾患を疑ったら

喘鳴を伴う呼吸困難：心不全だと思ったのに胸部X線でうっ血がはっきりしない

著者： 上田剛士¹

所属機関： ¹洛和会音羽病院総合内科

ページ範囲：P.552 - P.555

ポイント

★喘鳴を伴う呼吸困難を見たら閉塞性肺疾患（気管支喘息やCOPD）と心不全をまず考える．

★胸部X線写真では血流再分布（redistribution）やKerley's B lineを見落とさないように注意しながら読影する．

★追加検査としては脳性ナトリウム利尿ペプチド（BNP）や心臓超音波検査が有用であるが，いずれの検査も解釈には注意を要する．

参考文献

1）Wang CS, et al：Does this dyspneic patient in the emergency department have congestive heart failure? JAMA 294：1944-1956, 2005

2）McNamara RM, Cionni DJ：Utility of the peak expiratory flow rate in the differentiation of acute dyspnea. Cardiac vs pulmonary origin. Chest 101：129-132, 1992

3）Rothrock SG, et al：High yield criteria for obtaining non-trauma chest radiography in the adult emergency department population. J Emerg Med 23：117-124, 2002

4）Collins SP, et al；ADHERE Scientific Advisory Committee, Investigators and Study Group.：Prevalence of negative chest radiography results in the emergency department patient with decompensated heart failure. Ann Emerg Med 47：13-18, 2006

5）Gatt ME, et al：Chest radiographs in the emergency department：Is the radiologist really necessary? Postgrad Med J 79：214-217, 2003

6）Chakko S, et al：Clinical, radiographic, and hemodynamic correlations in chronic congestive heart failure：conflicting results may lead to inappropriate care. Am J Med 90：353-359, 1991

7）Mueller C, et al：The integration of BNP and NT-proBNP into clinical medicine. Swiss Med Wkly 137：4-12, 2007

8）Nagueh SF, et al：Doppler estimation of left ventricular filling pressure in sinus tachycardia. A new application of tissue doppler imaging. Circulation 98：1644-1650, 1998

9）Kasner M, et al：Utility of Doppler echocardiography and tissue Doppler imaging in the estimation of diastolic function in heart failure with normal ejection fraction：A comparative Doppler-conductance catheterization study. Circulation 116：637-647.（Epub）2007

10）Stein PD, et al：Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease. Chest 100：598-603, 1991

11）Miniati M, et al：Accuracy of clinical assessment in the diagnosis of pulmonary embolism. Am J Respir Crit Care Med 159：864-871, 1999