陳先生 56歲，六個月來逐漸發生氣喘及體重減輕現象，最近兩週運動後氣喘惡化。身體檢查發現血壓為 110/68 mmHg，但吸氣時收縮壓下降 20 mmHg，心跳 138 次/分，呼吸 22次/分，胸部X-ray顯示左肺有實質病變(left side consolidation)，其心電圖如下，請問最可能的診斷為何?
![圖片描述][ECG shows several important features:
Sinus tachycardia: The heart rate is fast, consistent with the clinical finding of 138 bpm.
Electrical alternans: There is a beat-to-beat variation in the amplitude of the QRS complexes. This is most evident in leads II, III, aVF, and the precordial leads V2-V6. Electrical alternans is a classic sign of cardiac tamponade, caused by the swinging motion of the heart within a large pericardial effusion.
Low voltage QRS complexes in limb leads: Although not definitively low voltage (defined as

Question

陳先生 56歲，六個月來逐漸發生氣喘及體重減輕現象，最近兩週運動後氣喘惡化。身體檢查發現血壓為 110/68 mmHg，但吸氣時收縮壓下降 20 mmHg，心跳 138 次/分，呼吸 22次/分，胸部X-ray顯示左肺有實質病變(left side consolidation)，其心電圖如下，請問最可能的診斷為何?
![圖片描述][ECG shows several important features:
Sinus tachycardia: The heart rate is fast, consistent with the clinical finding of 138 bpm.
Electrical alternans: There is a beat-to-beat variation in the amplitude of the QRS complexes. This is most evident in leads II, III, aVF, and the precordial leads V2-V6. Electrical alternans is a classic sign of cardiac tamponade, caused by the swinging motion of the heart within a large pericardial effusion.
Low voltage QRS complexes in limb leads: Although not definitively low voltage (defined as <5mm in all limb leads or <10mm in all precordial leads), the amplitude in lead I is relatively small, and this can be associated with pericardial effusion.](https://bgvxfcrmbdvefjhuvrmt.supabase.co/storage/v1/object/public/image/questions/NP-00-1/103/content/001e8f4c-243f-4e12-910d-ec9ded54edc2.webp)

ExamWise · Accepted Answer

(B) 肺癌合併心包轉移及心包填塞(lung cancer with pericardial metastasis and tamponade)

考選部 · Answer

(A) 嚴重肺栓塞(massive pulmonary embolism)

考選部 · Answer

(C) 感染性心內膜炎併敗血性肺栓塞(infective endocarditis with septic embolism)

考選部 · Answer

(D) 急性肺炎合併肋膜積液(acute pneumonia with massive pleural effusion)

詳細解析