胸膜性胸痛

Pleuritic Chest Pain

胸痛為臨床常見且重要之症狀，其鑑別診斷涵蓋多種心血管與非心血管疾病。心包膜炎之臨床表現多樣，常與其他胸痛相關疾病重疊，即使出現典型胸膜性胸痛，仍可能被誤認為心肌梗塞、心肌炎或腸胃道疾病，增加診斷困難。本個案因胸膜性胸痛就醫，心電圖顯示廣泛性ST段上升，但未合併心肌酵素上升，心臟超音波僅見少量心包積液及局部心室壁收縮異常。綜合臨床症狀、心電圖、血液檢查及影像學檢查結果，確立診斷為急性心包膜炎。由於心包膜炎與急性心肌梗塞在臨床表現及心電圖變化相似，但治療策略明顯不同，當胸痛合併ST段上升時，應將心包膜炎納入鑑別診斷，以利及早辨識並給予適當治療。

Chest pain is a common and important clinical symptom with a broad differential diagnosis encompassing both cardiovascular and non-cardiovascular conditions. The clinical presentation of pericarditis is highly variable and often overlaps with other causes of chest pain. Even in the presence of classic pleuritic chest pain, pericarditis may be misdiagnosed as myocardial infarction, pericardial effusion, or gastrointestinal disorders, complicating the diagnostic process. We report a case of pleuritic chest pain in which the electrocardiogram (ECG) demonstrated diffuse ST-segment elevations without concurrent elevation of cardiac enzyme levels. Transthoracic echocardiography revealed only a small pericardial effusion, making acute myocardial infarction less likely. Based on the clinical presentation, ECG changes, and imaging findings, acute pericarditis was diagnosed. Pericarditis and acute myocardial infarction can present with similar clinical features and ECG changes; however, their management strategies differ significantly. Therefore, when chest pain is accompanied by ST-segment elevation, pericarditis should be included in the differential diagnosis to ensure early recognition and appropriate treatment.