双源CT诊断儿童先天性冠状动脉瘘二例

例1 男,10岁.因心悸、胸闷就诊.心前区4/6级连续性杂音.心脏超声示:左冠状动脉内径1.3 cm,左心房内异常血流信号(左冠状动脉-左房瘘),心房水平可疑分流.双源CT示:左冠状动脉窦膨大,左冠状动脉窦房结支明显增粗扩张,于右心房后上壁进入右心房,瘘口直径约0.6 cm.增粗的窦房结支远段呈多发瘤样扩张(图1、2).心脏增大,以左心室、右心房、右心室增大为主.诊断:左冠状动脉-右心房瘘.     

先天性冠状动脉瘘的电子束CT诊断

目的探讨先天性冠状动脉瘘的电子束CT(EBCT)征象.材料和方法EBCT检查并手术证实的8例先天性冠状动脉瘘.EBCT采用单层增强扫描.结果EBCT提示4例右侧冠状动脉扩张迂曲,其中3例与心室、1例与主肺动脉沟通;4例源于左侧冠状动脉,其中1例对角支囊状扩张钙化与左室沟通,2例左圆锥支与主肺动脉连接,1例主干及回旋支扩张钙化,后者之左心房支与右心房沟通.结论无心脏手术史病例,EBCT提示冠状动脉及分支扩张迂曲,与心腔或其他血管异常沟通,应首先考虑先天性冠状动脉瘘.     

多层螺旋CT诊断左冠状动脉-右心房瘘一例

患者 女,39岁.因"活动后心悸、胸闷、气促、乏力1个月余"入院.体检:心界增大,心率62次/min,心前区可闻及Ⅲ/6级连续性杂音,以左侧第3、4肋间最明显,P2音增强.心脏彩超提示左冠状动脉-静脉瘘,肺动脉高压,轻度主动脉瓣关闭不全.64层螺旋CT三维及多平面重组MPR显示冠状动脉左主干及旋支明显增粗扩张,旋支末端汇入右心房,瘘口直径约7 mm,提示冠状动脉左旋支-右心房瘘,并伴有右心房室增大及肺动脉扩张.冠状动脉造影证实为冠状动脉左旋支-右心房瘘,并行封堵治疗.术后患者恢复良好,冠状动脉CTA复查提示瘘口完全阻塞.     

肺动脉栓塞误诊一例

患者 男，66岁。2个月前无明显诱因出现胸痛、胸闷，憋气、咯血，右下肢水肿。曾在外院诊断为“右下肺炎、心脏增大、心力衰竭”，对症治疗2个月仍未见好转来我院就诊。胸部X线片示：右下肺片状密度增高模糊影，心脏增大，右侧少量胸腔积液（图1）。CT示：右下肺片状密度增高病灶，其内可见三角形致密病灶，尖端指向肺门，心脏增大，右侧少量胸腔积液（图2）。肺动脉造影示：右下肺动脉主干阻断（图3）。诊断：肺动脉栓塞。     

两种球囊扩张术联合治疗重度肺动脉瓣狭窄一例

患者　女 ,12岁。自幼发现心脏杂音 ,近 2年来出现活动后心慌、气短。体检 :无发绀 ,胸骨左缘第 2肋间隙可闻及Ⅲ级收缩期杂音 ,震颤 (+) ,肺动脉瓣第 2音消失。心电图示右心室肥厚 ;Ｘ线平片示肺血少 ,肺动脉段呈直立性突出合并右心房及右心室增大 ;心脏超声示右心房、右心室增大 ,肺动脉瓣增厚 ,开放明显受限 ,关闭尚可。肺动脉跨瓣压差为 88ｍｍＨｇ(1ｍｍＨｇ =0 133ｋＰａ) ,肺动脉瓣口可探及高速血流信号 ,提示重度肺动脉瓣狭窄 ,遂决定实施肺动脉瓣球囊扩张术。常规经右股静脉插管 ,先作右心室造影 ,显示肺动脉瓣增厚以及开放受限 ,…     

心力衰竭患者胸部CT征象及其临床意义分析

目的通过对心力衰竭患者的胸部CT征象进行回顾性分析,提高心力衰竭患者的临床诊断率。方法 2015年1月~2016年5月在我院就诊并经临床确诊的心力衰竭患者80例,根据心力衰竭发生的时间、速度、严重程度将患者分为急性心力衰竭组(37例)及慢性心力衰竭组(43例),分析80例患者的临床症状及CT影像资料,对两组心力衰竭患者胸部CT影像学特点进行对比分析。结果急性心力衰竭组患者胸部CT多表现为肺泡性肺水肿,双肺野中内带呈现斑片状或云雾状密度增高影,内部可见支气管充气征,病变进展期大多数表现为双肺广泛密度实变影,少数病例可见"蝶翼征"。慢性心力衰竭组患者胸部CT表现以间质性肺水肿为主,表现为小叶间隔及支气管壁的增厚,支气管血管束以及肺门模糊、增粗,并可见磨玻璃影。两组患者多数可见心脏外形的增大(49/80),少量心包积液(47/80)及胸腔积液(41/80),胸腔积液多为双侧性且右侧量多于左侧量。结论胸部CT检查能够显示急、慢性心力衰竭患者的特征性影像学表现,可为心力衰竭的临床诊治提供可靠依据。     

采用Duct-Occlud弹簧栓子封堵巨大冠状动脉瘘

冠状动脉瘘是一种少见的先天性心血管畸形。病人早期大多无症状,随着年龄增长而出现心绞痛、细菌性心内膜炎、心力衰竭等,因此必须早期进行治疗。我们采用ＤｕｃｔＯｃｃｌｕｄ弹簧栓子(德国ＰＦＭ公司制造)成功地封堵1例巨大冠状动脉右心室瘘,现介绍如下。患儿　男,5岁。2岁时因病就诊发现心脏杂音,平素活动同正常儿童。体检:于胸骨右缘4～5肋间闻及连续性杂音,肺动脉区第2音分裂。心电图示:电轴正常,左心室肥厚。胸部Ｘ线平片:示肺血增多,右心房与右心室增大,心胸比率060。超声心动图:示右冠状动脉呈管状增粗,根部达12ｍｍ,引流至右心室流…     

MRI对慢性高原病患者心脏结构和功能的评价研究

目的探讨心脏磁共振成像(CMRI)对慢性高原病(CMS)患者在心脏结构及功能方面的应用价值。方法选取分析30例CMS患者的CMRI影像学资料,另选取30例健康正常志愿者作为对照组。测定心脏结构参数:前室间隔厚度、左心室舒张末期内径、左心房内径、主动脉根部内径、主肺动脉内径、右心室流出道宽径、右心房横径、右心房长径、右心室横径、右心室长径;另测定左、右心室心功能参数:舒张末期容积(EDV)、收缩末期容积(ESV)、每搏输出量(SV)、射血分数(EF)和右心室心肌质量(RVMM),对两组参数进行对比分析。结果在心脏结构方面,CMS组前室间隔厚度、主肺动脉内径、右心室流出道宽径、右心房长径和右心室长径显著对照组(P 0.05);在左、右心功能方面,CMS组RVMM明显对照组(P 0.05),RVSV和RVEF明显对照组(P 0.05)。结论 CMRI可准确评价CMS患者心脏结构及功能,CMS患者以右心结构及功能改变为主。     

未行肾替代治疗的尿毒症肺的CT征象分析

目的 探讨尿毒症肺的CT表现特征.方法 收集尿毒症伴呼吸道症状或胸部平片发现异常的患者34例,其中慢性肾小球肾炎合并尿毒症29例、糖尿病肾病合并尿毒症3例,多囊肾合并尿毒症2例.全部病例均行64排螺旋CT检查,总结尿毒症肺的CT表现.结果 34例患者肺部存在的病变主要有肺泡性肺水肿(28/34)、间质性肺水肿(23/34)、肺淤血(34/34)、胸腔积液(19/34)、肺动脉高压(12/34)以及肺钙化(2/34).结论 未行替代疗法的尿毒症肺患者的胸部CT表现具有一定特征性.     

64层螺旋CT肺血管造影在肺栓塞诊疗中的应用价值

目的 探讨64层螺旋CT在肺栓塞诊断及治疗中的指导作用。方法 63例患者均行64层螺旋CT肺血管造影(CTPA),并进行多种形式的图像重建结合轴位图像分析。结果 64层螺旋CTPA对63例患者肺动脉各级管腔内的栓子均明确显示,共累及肺动脉303支;图像分析结果伞部显示肺栓塞的直接征象为:主肺动脉和(或)左右肺叶、段、亚段血管腔内充盈缺损和血管阻塞;部分显示肺栓塞的间接征象为:马赛克征、右心房及右心室肥厚及扩张、肺动脉扩张、胸腔积液、肺不张及实变(肺梗死)等。62例患者经溶栓治疗后复查CTPA,其中,栓子完全消失者47例,栓子明显缩小者11例,溶栓治疗效果差者3例,考虑为慢性肺栓塞。结论 64层螺旋CTPA是临床最有效的诊断肺栓塞及溶栓后疗效评价的无创性方法之一。     

螺旋CT诊断急性肺栓塞的价值

目的:评价螺旋CT诊断急性肺栓塞的价值。方法:对临床拟诊肺栓塞108例患者行胸部扫描和肺动脉造影,同时检测患者血浆D-二聚体。结果:108例螺旋CT胸部扫描和肺动脉造影中,肺动脉栓塞53例,其中右肺动脉栓塞11例、左肺动脉栓塞6例和双侧36例,合并胸水10例、心包积液3例和肺梗死5例。血浆D-二聚体低于250μg/L的6例。排除肺栓塞并检出和诊断为其他疾病55例,其中包括心功能不全致间质性肺水肿、胸水10例,肺炎5例,肺结核5例,胸水、心脏增大3例,肺癌1例,纵隔淋巴结肿大2例,胸水、胰腺炎1例,降主动脉附壁血栓1例,肺间质纤维化1例。结论:螺旋CT肺动脉造影能早诊断和排除肺栓塞,造影前必须行CT平扫,以便检出和诊断胸部其他病变,螺旋CT可作为肺栓塞的首选检查方法。     

Congenital complete heart block. Radiographic findings in 13 patients without associated defects.

The radiographic findings in 13 patients with congenital complete heart block without associated anomalies are presented to illustrate characteristic features. Findings related to the increased stroke volume in these patients include: (a) simulated shunt vasculature; (b) pulmonary venous pypertension with redistribution of blood flow to the upper lungs, and, in one patient, peribronchial edema; (c) cardiomegaly with right ventricular, pulmonary artery, left atrial, left ventricular, and aortic enlargement; and (d) variation in cardiac size on serial examinations. Less commonly seen were findings related to atrioventricular dissociation with transitory marked pulmonary venous hypertension present in one patient when left atrial contraction occurred during ventricular systole when the mitral valve was closed.     

甲亢性心脏病房颤患者的心肺X线表现分析

目的：分析与讨论甲状腺机能亢进性心脏病中房颤改变与X线表现意义。方法：按俞氏诊断标准排除其它疾病的40例甲心病,均在治疗前摄后前位（远达）X线胸片,其中合伴房颤36例（阵发性房颤16例,快速性房颤16例,房扑4例）。结果：X线线中肺淤血（肺静脉高压）,左房大与房颤关系明显,肺淤血程度和左房大与房颤改变联系紧密,对临床治疗有帮助。除此外甲心病XC线表现有高动力循环表现如肺血多,肺动脉段膨,右下肺动脉增粗,心脏改变如左室大、心衰等。结论：甲心病中房颤X线表现与病理改变关系密切,认识与注意相关X线表现对治疗有帮助,且意义较大。     

Computed tomography of partial anomalous pulmonary venous connection in adults

OBJECTIVES: To systematically describe the imaging features and clinical correlates of a partial anomalous pulmonary venous connection diagnosed on computed tomography (CT) in adults. METHODS: Twenty-nine adults with a partial anomalous pulmonary venous connection on CT were retrospectively identified. There were 19 women and 10 men, with a mean age of 53 (range: 19-83) years. Four cases were identified by review of 1825 consecutive chest CT reports from July 2000-July 2001, and 25 cases were culled from chest radiology teaching files at 3 institutions. Inclusion criteria were availability of CT images and medical charts. Chest radiographs (25 of 29 cases) were reviewed for mediastinal contour abnormalities, heart size, and pulmonary vascular pattern. Chest CT scans were reviewed for location, size, and drainage site of the anomalous vein; presence or absence of a pulmonary vein in the normal location; cardiac size and configuration; and pulmonary vasculature. Charts were reviewed for evidence of pulmonary and cardiovascular disease, history of congenital heart disease, and results of other cardiac imaging. RESULTS: The prevalence of a partial anomalous pulmonary venous connection was 0.2% (4 of 1825 chest CT reports). Seventy-nine percent (23 of 29 patients) had an anomalous left upper lobe vein connecting to a persistent left vertical vein, only 5% (1 of 23 patients) of whom had a left upper lobe vein in the normal location. Seventeen percent (5 of 29 patients) had an anomalous right upper lobe vein draining into the superior vena cava, 60% (3 of 5 patients) of whom also had a right upper lobe pulmonary vein in the normal location. One patient (3%) had an anomalous right lower lobe vein draining into the suprahepatic inferior vena cava. Chest radiographic findings were abnormal left mediastinal contour in 64% (15 of 25 patients), abnormal right mediastinal contour in 8% (2 of 25 patients), and cardiomegaly in 24% (6 of 25 patients). Computed tomography findings were cardiomegaly in 48% (14 of 29 patients), right atrial enlargement in 31% (9 of 29 patients), right ventricular enlargement in 31% (9 of 29 patients), and pulmonary artery enlargement in 14% (4 of 29 patients). Pulmonary or cardiovascular symptoms were present in 69% (20 of 29 patients), 55% (11 of 20 patients) of whom had specific alternative diagnoses (excluding congestive heart failure and pulmonary hypertension) to explain the symptoms. Only 1 patient (3%) was diagnosed with a secundum atrial septal defect. CONCLUSIONS: A partial anomalous pulmonary venous connection was seen in 0.2% of adults on CT. In contrast to previous series focusing on children, the anomalous vein in adults was most commonly from the left upper lobe, in women, and infrequently associated with atrial septal defects.     

Pr?valenz und klinische Bedeutung inzidenteller Herzbefunde im nicht EKG-getriggerten Thorax-CT

Background

The purpose of this study was to evaluate the prevalence and clinical significance of incidental cardiac findings in non-ECG-gated chest CT.

Patients and methods

Non-ECG-gated chest CT examinations of 300 patients were retrospectively analyzed for incidental cardiac findings. Subsequently, these findings were evaluated for their clinical relevance by a cardiologist.

Results

A total of 107 out of 300 examined patients had 174 incidental cardiac findings including coronary calcification (90), aortic/mitral valve calcification (42), iatrogenic changes (23), pericardial effusion (6), dilatation of the heart (4), myocardial changes (3), thrombus in the left ventricle (2), constrictive pericarditis (2) and atrial myxoma (1). Of the cardiac findings 51% were described in the written report and in 53 out of the 107 patients the cardiac findings were unknown. Newly detected incidental findings from 8 patients were rated as clinically significant: pericardial effusion (4), constrictive pericarditis (1), thrombus in the left ventricle (1), atrial myxoma (1) and dilatation of the heart (1).

Conclusion

Incidental cardiac findings are frequent in non-ECG-gated chest CT and may have a high clinical relevance.     

多层螺旋CT对肺动脉栓塞的诊断价值

目的探讨肺动脉栓塞(pu lmonary embolism,PE)的多层螺旋CT(MSCT)表现特征,评价MSCT对PE的诊断价值。方法回顾分析43例临床诊断PE患者的16层螺旋CT肺动脉造影资料的影像学表现,并与其肺动脉造影(DSPA)或随访结果相对照。结果本组43例均与临床诊断相符,中心型16例,周围型23例,混合型4例。多层螺旋CT肺动脉造影(MSCTPA)对叶及叶以上肺动脉的显示率达100%,检出PE阳性20支,段肺动脉清楚显示726支(显示率达84.4%),检出PE阳性109支,亚段肺动脉清楚显示1185支(显示率达68.9%),检出PE阳性61支。PE的直接征象包括血管腔完全闭塞、部分充盈缺损、轨道征和附壁血栓;间接征象有肺梗死灶、“马赛克”征、右室增大和/或肺动脉扩张、胸腔积液、心包积液等。结论MSCTPA诊断PE简便、安全、无创,对亚段肺动脉栓塞的诊断准确、可靠,是诊断早期肺动脉栓塞的首选方法。     

肺动脉闭锁伴室间隔缺损的多层螺旋CT诊断

目的:回顾性分析肺动脉闭锁伴室间隔缺损(PAVSD)的多层螺旋CT(MSCT)表现。方法:分析5例肺动脉闭锁伴室间隔缺损患者的MSCT图像。4例行平扫及双期扫描,另1例行单期扫描。结合薄层图像、多平面重组、薄层最大密度投影以及容积再现法进行观察。结果:MSCT显示肺动脉瓣闭锁2例,肺动脉干中断、无中央共汇者3例。5例均见室间隔缺损。2例见明显的支气管动脉扩张;2例见直接主动脉肺动脉侧支;2例见间接主动脉肺动脉侧支。1例合并右心室发育不良及三尖瓣狭窄,1例合并房间隔缺损;3例合并右位主动脉弓,2例合并主动脉后左无名静脉。1例有手术史者可见上腔静脉与右肺动脉吻合,与右心房无交通。结论:MSCT可清楚地显示PAVSD的主要表现。     

Pulmonary embolism, right ventricular strain, and intracardiac thrombus-in-transit: Evaluation using comprehensive cardiothoracic computed tomography

A 67-year-old woman presented with symptoms of exertional chest discomfort and dyspnea that had been progressive over the past few days. Her initial evaluation was significant of a mildly elevated troponin-T level and T-wave inversion in leads V₁-V₂ on an electrocardiogram (ECG). Initial suspicion was for acute coronary syndrome. However, a transthoracic echocardiogram showed normal left ventricular systolic function, moderate right ventricular enlargement with moderate decrease in systolic function, possible left atrial mass or thrombus, and a possible right atrial mass or thrombus versus a prominent Chiari network. ECG-gated comprehensive cardiothoracic computed tomography (CT) with a 64-slice multidetector CT was done to assess for pulmonary embolism or acute coronary syndrome and to further evaluate the possible right and left atrial masses. This showed large bilateral pulmonary embolism, interatrial thrombus in transit through a patent foramen ovale, and minimal coronary atherosclerosis. Dynamic imaging showed right ventricular enlargement with severe systolic dysfunction. The patient underwent successful pulmonary thromboembolectomy, removal of intracardiac thrombus, and closure of patent foramen ovale.     

心肌梗塞X线心脏形态改变的探讨

本文结合心电图对７２例心肌梗塞Ｘ线胸片进行观察，探讨心肌梗塞心脏Ｘ线表现及其相关因素，结果如下：１、心脏增大率５４．２％，左心室增大为主，７６．９％呈主动脉型增大。左心房增大与左心衰和乳头肌功能异常有关。右心室增大多为继发性。２、心肌缺血是心肌梗塞心脏增大的主要原因，缺血组心脏增大率及左心横径均数都高于无缺血组（Ｐ均＜０．００５）。前壁大面积梗塞也是导致心脏增大的原因之一。高血压并非影响心肌梗塞心脏增大的主要原因。３、２６．４％病例显示肺循环异常，上肺静脉扩张是常见表现。肺循环异常的发生率随心脏增大程度而升高（Ｐ＜０．００５）。     

20例肺动脉栓塞螺旋CT增强扫描的影像分析

目的:研究肺动脉栓塞螺旋CT增强扫描的影像表现,充分认识肺栓塞的CT征象,提高肺栓塞的诊断水平。方法:共20例,男14例,女6例。使用东芝Xpress/SXCT扫描机作造影增强螺旋CT扫描。统计分析肺叶及肺叶以上肺动脉栓塞CT增强的综合表现。结果:肺动脉栓塞原发病以下肢深静脉血栓形成最为多见,有7例。下肢深静脉血栓有2例是由桑拿浴引起。将肺栓塞的程度分为轻度栓塞、中度栓塞、重度栓塞和完全栓塞。轻度栓塞为栓塞面占肺动脉管径<30%;中度栓塞为栓塞面30%～50%;重度栓塞为栓塞面>50%,周围仍见对比剂显影或通过;完全栓塞的栓塞面周边无对比剂显影通过。肺动脉栓塞直接征象是栓塞部位不强化,呈充盈缺损改变。此外,还见9个继发征象:肺动脉总干增宽,右心室和右心房增大。肺叶透亮度增加,肺血管纹理稀疏、细小。肺静脉变小,基底静脉变小,边缘不整,呈干藤样改变。左心房变小。左心室亦变小,室间隔向左后移位。肺组织实变,呈三角形。胸腔积液和心包积液。结论:肺动脉栓塞胸部螺旋CT增强扫描的表现是一组综合征象,笔者称为肺栓塞10联征。充分认识10联征,能大大提高肺栓塞的诊断水平。肺动脉栓塞有多种原发病,以下肢深静脉血栓形成最多见,桑拿浴可引起下肢深静脉血栓,可能是肺栓塞的一个诱因。