以胸痛為表現的致命感染性疾病的評估與處置

Evaluation and management of life-threatening infectious diseases presenting as chest pain

糖胸痛為常見的臨床徵象，其潛在疾病包括心血管、肺臟、肋膜、縱腸、食道、胃及腹部臟器，在內科加護及急診實務首要，在立即確認並排除致命性胸痛的可能。鑑別診斷潛在疾病，並給予最適當的處置為臨床主軸。一般致命性胸痛評估，以急性冠心症、肺栓塞、主動脈剝離、氣胸及心包膜填塞為主。然而感染性疾患因其各樣原因、病原體、敗血症風險與相關併發症，亦具有高度潛在致命性。以胸痛表現之致命性感染疾病包括心血管感染如心肌炎、心包膜炎併填塞、心內膜炎及感染性動脈瘤；肺臟肋膜感染，如敗血性肺栓塞、壞死性肺炎、肺膿瘍、膿胸、肋膜炎；縱膈炎；消化器牽引性胸痛。在此我們整理現行相關臨床處理原則。

Chest pain is a common clinical symptom with many potential etiologies of chest pain, including diseases of the heart, aorta, lungs, pleura, mediastinum, and abdominal viscera. Immediate recognition and exclusion of life-threatening causes of chest pain is first of all importance to clinicians in medical intensive care and emergency practice. The differential diagnosis with optimal treatment of underlying diseases is the main approach to patients with presenting as chest pain. The evaluation of underlying life-threatening chest pain generally focuses on acute coronary syndrome, pulmonary embolism, aortic dissection, pneumothorax, and cardiac temponade. However, infectious diseases causing chest pain also have high life-threatening potential if ignored clinically because of the varied causes, pathogens, and risk of sepsis and related complications. Life-threatening infectious diseases presenting as chest pain includes cardiovascular infection (e.g. myocarditis, pericarditis, infectious endocarditis, and mycotic aneurysm), pulmonary and pleural infection (e.g. septic pulmonary embolism, lung abscess or necrotizing pneumonia, empyema), mediastinitis, and referred pain from gastrointestinal infection. So we review current principles about approaches to life-threatening infectious diseases presenting as chest pain.