BACKGROUND & AIMS: :Pulmonary involvement may sometimes be the initial presentation of Takayasu's arteritis (TA). Since the signs and symptoms of pulmonary TA may be subtle and may not be easily distinguishable from other pulmonary diseases, one has to maintain a high index of suspicion. Cases of pulmonary TA mimicking chronic thromboembolism have been reported. We describe a patient with TA whose initial presentation mimicked acute pulmonary embolism. The patient presented with a 3-day history of cough and shortness of breath and had multiple bilateral perfusion defects on ventilation-perfusion scan, typical of acute pulmonary embolism. However, the constellation of clinical features, elevated erythrocyte sedimentation rate and the angiographic appearance helped us establish the correct diagnosis of pulmonary Takayasu's arteritis. At a 6-year follow-up, the patient had no worsening of pulmonary symptoms but presented with postural dizziness with angiographic evidence of carotid and innominate artery stenosis; she underwent arterial bypass grafting. In young women presenting with a clinical picture of acute pulmonary embolism without the previous history (or risk factors) of thromboembolism, pulmonary TA must be considered in the differential diagnosis.

背景与目标： ：有时肺部受累可能是Takayasu的动脉炎（TA）的最初表现。由于肺部TA的体征和症状可能很细微，可能难以与其他肺部疾病区分开，因此必须保持高度怀疑的指数。已经报道了模仿慢性血栓栓塞的肺部TA病例。我们描述了一名TA患者，其最初表现为急性肺栓塞。该患者有3天的咳嗽和呼吸急促病史，并且在通气灌注扫描中有多个双侧灌注缺陷，这是典型的急性肺栓塞。但是，临床特征的星座，红细胞沉降率的升高和血管造影的出现帮助我们建立了对肺隆隆动脉炎的正确诊断。在为期6年的随访中，患者的肺部症状没有恶化，但表现为姿势性头晕，并伴有颈动脉和无名动脉狭窄的血管造影证据。她进行了动脉旁路移植术。对于表现出急性肺栓塞临床表现但无血栓栓塞既往史（或危险因素）的年轻女性，在鉴别诊断中必须考虑肺部TA。

BACKGROUND & AIMS: PURPOSE:The purpose of this investigation is to determine the characteristics of the history, physical examination, chest radiograph, and ECG, and the ventilation/perfusion (V/Q) lung scan probability in patients with pulmonary embolism (PE) stratified according to their presenting syndrome.

BACKGROUND:In considering a possible diagnosis of acute PE, it is helpful to consider the patient in terms of the presenting syndrome (pulmonary infarction, isolated dyspnea, or circulatory collapse). In assessing the possibility of acute PE, it would be more useful to know the detailed characteristics of the particular syndrome rather than the clinical characteristics of all patients with PE.

METHODS:Patients described in this investigation participated in the national collaborative trial of the Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED). All had PE diagnosed by pulmonary angiography. None had prior cardiopulmonary disease. All examinations and laboratory tests were obtained within 24 h of the pulmonary angiogram and most were within 12 h of the pulmonary angiogram.

RESULTS:Among patients with the pulmonary infarction syndrome, 14 of 119 (12%) had neither dyspnea nor tachypnea. Some patients with circulatory collapse did not have dyspnea, tachypnea, or pleuritic pain. A normal ECG was more prevalent among patients with pulmonary infarction syndrome, 45 of 97 (46%), than among patients with isolated dyspnea syndrome, 2 of 21 (10%) (p<0.01). A PaO2 >80 mm Hg was also more prevalent in patients with the pulmonary infarction syndrome, 27 of 99 (27%), than in patients with the isolated dyspnea syndrome, 2 of 19 (11%). A high-probability V/Q lung scan was less prevalent among the pulmonary infarction group, 38 of 119 (32%), than the isolated dyspnea group, 20 of 31 (65%) (p<0.001).

CONCLUSION:Many of the findings in the various syndromes of PE can be understood in terms of the severity of PE as it increases from mild with the pulmonary infarction syndrome to moderate with the isolated dyspnea syndrome to severe with circulatory collapse. The prevalence of various clinical and laboratory characteristics of patients with the syndrome of pulmonary infarction, isolated dyspnea, or circulatory collapse may give clues to the diagnosis or suggest characteristics that may reduce the likelihood of inadvertently discarding the diagnosis of PE.

背景与目标： 目的：这项研究的目的是确定肺栓塞患者的病史，体格检查，胸部X光片和ECG的特征以及通气/灌注（V / Q）肺扫描的可能性（PE）根据他们的表现综合征进行分层。

背景：在考虑对急性PE进行可能的诊断时，从表现综合征（肺梗塞）的角度考虑患者是有帮助的，孤立的呼吸困难或循环衰竭）。在评估急性PE的可能性时，了解特定综合征的详细特征而不是所有PE患者的临床特征将更有用。

方法：描述的患者在这项调查中，参加了肺栓塞诊断前瞻性调查（PIOPED）的国家合作试验。所有患者均经肺动脉造影诊断为PE。没有人曾患过心肺疾病。

结果：在患有肺梗死综合征的患者中，有14例在肺血管造影的24小时内进行了所有检查和实验室检查，大部分在肺血管造影的12小时以内。 119（12％）没有呼吸困难或呼吸急促。一些循环衰竭的患者没有呼吸困难，呼吸急促或胸膜疼痛。正常的心电图在肺梗死综合征患者中更为普遍，为97例中的45例（46％），而在孤立呼吸困难综合征患者中为21例中的2例（10％）（p <0.01）。肺梗死综合征患者中，PaO2> 80 mm Hg的患病率也更高，占99例中的27例（占27％），而单纯呼吸困难综合征中的19例中有2例（占11％）。在肺梗死组中，高概率V / Q肺扫描的发生率较低，为119例中的38例（32％），比单独的呼吸困难组中的20例（65％）低（P <0.001）。

> 结论：从PE的严重程度来看，PE的各种症状中的许多发现都可以理解，因为PE的程度从轻度的肺梗死综合征增加到中度的单纯呼吸困难综合征到重度的PE循环系统崩溃。患有肺梗塞，孤立的呼吸困难或循环衰竭的患者的各种临床和实验室特征的普遍性可能为诊断提供线索，或提示可能减少无意中放弃PE诊断的可能性的特征。