心脏原发良性肿瘤的临床分析及超声诊断价值

目的　评价黏液瘤以外的心脏原发良性肿瘤的临床特点、手术所见、病理学类型以及治疗情 况;评价超声心动图诊断黏液瘤以外的心脏原发良性肿瘤的准确性。方法　手术和病理证实为心脏良性 肿瘤患者26例。回顾性分析临床及术前超声心动图检查资料。结果　26例患者中,46.15%(12例)肿瘤 位于左心,38.46%(10例)位于右心,3.85%(1例)位于双心室,11.54%(3例)位于心包。26例中,脂肪瘤 6例(23.08%),淋巴管瘤5例(19.23%),纤维瘤4例(15.38%),横纹肌瘤4例(15.38%),平滑肌瘤2例 (7.69%),海绵状血管瘤2例(7.69%),嗜铬细胞瘤1例(3.85%),淋巴管囊肿1例(3.85%),心外膜囊肿 1例(3.85%)。4例横纹肌瘤均位于右心室,5例淋巴管瘤均位于左心室。横纹肌瘤与脂肪瘤、淋巴管瘤、 血管瘤及平滑肌瘤之间发病年龄差别具有显著性意义(P<0.01)。26例中,术前超声诊断心脏占位病变 性质待定22例(84.62%),诊断黏液瘤可能性大4例(15.38%)。结论　心脏良性肿瘤多位于左心,其次右 心,少数位于心包。不同类型心脏良性肿瘤可发生于不同年龄段。     

超声心动图对心脏粘液瘤的诊断及随访价值

目的:探讨超声心动图在心脏粘液瘤患者术前诊断、术后随访中的应用价值。方法:纳入2010年1月至2018年6月经手术及病理确诊为心脏粘液瘤的患者共37例,分析其术前、术后的超声心动图特征。结果:术前超声心动图对心脏粘液瘤特征的评价,如大小、位置、瘤蒂等,与手术所见一致。术后1个月复查超声心动图,左房粘液瘤患者左心内径较术前减小,左室射血分数较术前降低(P0.05)。右房粘液瘤患者右房内径比术前回缩。术前二尖瓣或三尖瓣口阻塞的患者,术后相应瓣口血流速度均恢复正常。术后12个月复查超声心动图显示,所有患者均无复发。结论:超声心动图对心脏粘液瘤的术前评估、术后随访具有重要的价值。     

心脏黏液瘤的外科治疗体会

目的 总结心脏黏液瘤的诊断及外科治疗体会.方法 回顾性分析山东大学齐鲁医院1990年1月至2007年5月收治的127例及厦门心脏中心近4年所收治的6例心脏黏液瘤患者临床资料.术前均经二维超声心动图明确诊断,其中肿瘤位于左心房109例、右心房22例、双心房2例.均在体外循环下取胸部正中切口,经右心房-房间隔途径摘除黏液瘤.同期行二尖瓣成形术11例,三尖瓣成形术6例.切除肿瘤均送检病理.结果 术后早期因严重低心排血量综合征死亡2例,术后新发脑栓塞6例,左下肢栓塞1例,肺栓塞1例.余患者术后未出现严重并发症,自觉症状较术前明显好转,心脏体征消失,痊愈.病理检查结果 均显示为心脏黏液瘤.结论 心脏黏液瘤多为良性,但引起的临床后果严重,一经诊断应尽早手术摘除;术中严防肿瘤脱落是手术成功的关键,且应注意术后随访;二维超声心动图是诊断心脏黏液瘤的最佳方法 .     

原发性心脏肉瘤的超声诊断与病理对照分析

目的 探讨利用超声心动图诊断原发性心脏肉瘤的价值。 方法 自1998年1月至2005年8月，本心脏中心13例经手术病理证实的原发恶性心脏肉瘤患者进行了经胸超声心动图检查，将超声与手术病理进行对照。 结果 与手术病理结果对比，经胸超声心动图检出12例心脏-心包占位，1例漏诊，敏感性92．3％。在判定肿瘤良恶性时，4例超声误认为是黏液瘤但病理证实为肉瘤，另有2例超声误认为恶性肿瘤但病理证实为良性，敏感性61．5％，特异性86．6％。 结论 经胸超声心动图对原发心脏肉瘤具有诊断价值，可为治疗决策提供重要的诊断信息。     

心脏原发性肿瘤的超声诊断与病理分析

目的 :探讨二维超声心动图技术诊断心脏原发性肿瘤的价值。方法 :对术前超声心动图诊断的心脏原发性肿瘤患者 2 9例 ,进行回顾性分析其声像学特点 ,并与手术和病理结果进行对比。结果 :粘液瘤 2 5例 ,血管肉瘤 2例、横纹肌瘤 1例、乳头状纤维瘤 1例 ,各种心脏原发性肿瘤均具有特征性的声像学特点。结论 :超声心动图对心脏原发性肿瘤具有较高的诊断准确性 ,对大多数病例均可于术前作出定性、定位诊断或鉴别诊断 ,可为制定临床治疗方案提供重要信息     

实时三维超声心动图在婴幼儿原发性心脏肿瘤诊断中的临床价值

目的 探讨实时三维超声心动图（RT-3DE）诊断婴幼儿原发性心脏肿瘤的临床价值。方法 回顾性分析3例婴幼儿原发性心脏肿瘤术前RT-3DE表现,并与术中所见和术后病理结果进行对比分析。结果 3例患儿RT-3DE表现均与手术所见相符合,经病理证实为心脏脂肪瘤1例,横纹肌瘤2例。结论 RT-3DE能快速显示婴幼儿原发性心脏肿瘤的特征,对临床诊断有重要价值。     

心脏肿瘤的超声心动图表现及病理类型分析

目的回顾分析心脏肿瘤的临床表现、超声心动图特征及手术病理分型的特点,探讨超声诊断肿瘤的要点,提高诊断准确率。方法对在我院手术的263例心脏肿瘤患者的临床资料、超声结果进行回顾性分析,并与术中大体及术后病理相对照。结果 (1)263例病例中,男107例,女156例,年龄1~81岁,平均(51.8±14.8)岁。(2)按照WH0(2015)心脏肿瘤分类:良性肿瘤214例(81.3%),恶性肿瘤45例(17.1%),生殖细胞肿瘤1例(0.4%),生物学行为未明3例(1.1%)。(3)214例良性肿瘤中,黏液瘤最多见,176例(82.2%),其次是脂肪瘤,11例(5.2%)。45例恶性肿瘤中,肉瘤最常见,共33例(67.4%)。(4)肿瘤发生部位:左房最常见,155例(58.9%),其次是右房,56例(21.3%)。多心腔8例(占3.0%),其中4例为黏液瘤,4例为恶性肿瘤。结论应用超声心动图可探查心脏肿瘤。根据肿瘤发病比率、发生部位及影像学特点,结合病史可为手术前诊断提供更准确信息。     

右心房肿瘤的超声心动图影像学特征及病理结果分析

目的分析右心房肿瘤的超声影像特征及病理结果,为提高心脏肿瘤诊断水平提供依据。方法连续收集94例超声诊断为右心房肿瘤患者的超声心动图及病理资料,分析总结右心房肿瘤的常见类型及影像特征。结果 94例超声诊断为右心房肿瘤的患者58.5%有心电图异常,以T波及ST段改变为主(67.3%)。其继发改变以右心扩大为主(右房扩大46.8%,右室扩大24.5%),部分患者伴有三尖瓣梗阻(21.3%)和心包积液(13.8%,多为恶性肿瘤),极少数患者伴有肺高压(2.1%)。与病理结果对照,超声诊断符合率为94.7%(89/94),误诊为肿瘤的常见类型为血栓及血囊肿。病理确诊的89例右心房肿瘤中良性肿瘤偏多(55.1%),转移肿瘤居多(52.8%):原发于肝脏的恶性转移瘤居首位(25.8%),良性静脉平滑肌瘤为右心房第二常见转移瘤类型(13.5%);原发性良性肿瘤按发病率依次为黏液瘤、脂肪瘤、纤维组织瘤样增生(30.3%,4.5%,3.4%)。结论右心房肿瘤以良性居多,转移肿瘤比原发肿瘤多见(良性静脉平滑肌瘤亦常发生右心转移)。超声心动图可协助判断肿瘤的良恶性、评估原发灶,为术前的诊疗决策提供重要依据。     

经胸超声心动图对心脏创伤诊断价值

目的本研究旨在评估经胸超声心动图在心脏创伤中的应用价值。方法回顾性分析15例心脏创伤患者的临床资料和超声心动图影像资料,超声诊断与手术结果进行比较。结果超声心动图检出心包积液13例,其中9例伴血凝块形成,右室侧壁穿孔1例,三尖瓣腱索断裂伴重度三尖瓣反流1例,二尖瓣腱索断裂伴后叶穿孔1例,室间隔穿孔2例,金属异物存留1例,主动脉右冠瓣脱垂1例,右冠窦-右室分流1例。超声心动图对瓣膜损伤、室间隔穿孔、心包积液及异物存留的诊断与手术结果完全符合。漏诊右室壁穿孔4例,右室挫伤2例,右房壁穿孔2例,升主动脉近端壁血肿1例。结论超声心动图检查是诊断心脏创伤快捷、有效的方法,且能在床旁进行急诊检查,对诊断心脏创伤诊断具有重要临床价值,并指导临床治疗。     

超声心动图检查心脏转移性肿瘤患者肿瘤部位与临床病理相关性研究

目的分析心脏转移性肿瘤患者的超声心动图肿瘤部位检测结果与病理检查结果之间的关系,为临床诊治提供参考。方法回顾性分析2012年至5月至2015年7月来我院诊断的200例心脏转移性肿瘤患者,分析其病理学检查结果、超声心动图肿瘤位置检查结果,并分析二者之间的关系。结果超声心动图显示心包异常98例(49.0%),心肌异常40例(20.0%);累及右心房和右心室38例(14.0%)。74例肺癌肿瘤心脏转移患者中,30例患者在超声心动图上显示心包异常,22例心肌异常,14例右心房和右心室异常,8例左心室和左心房异常。病理诊断为乳腺癌、白血病、间皮瘤以及胸腺肿瘤的肿瘤心脏转移患者超声心动图显示心包异常率均明显高于病理诊断为肺癌肿瘤心脏转移患者(P<0.05)。在病理学诊断为乳腺癌、恶性黑色素瘤、淋巴瘤、白血病和间皮瘤的患者出现心肌异常的比例均显著低于病理学诊断为肺癌的患者(P<0.05)。累及右心房和右心室的病理学诊断为肺癌、乳腺癌、恶性黑色素瘤与淋巴瘤的心脏转移性肿瘤患者所占比例最高,与其他患者比较具有统计学意义(P<0.05)。结论不同类型肿瘤患者发生肿瘤心脏转移者的超声心动图肿瘤部位分布具有一定的特征,对肿瘤患者心脏转移诊断治疗具有较高的参考价值。     

心脏淋巴瘤的超声特征及临床资料分析

目的 探讨心脏淋巴瘤患者的心脏超声特征性表现,为患者早诊断、早治疗提供重要信息。资料与方法 回顾分析我院2016年1月至2022年5月期间确诊并有累及心脏的21例淋巴瘤患者的心脏超声图像及其临床诊治资料。结果 心脏淋巴瘤最常累及右房、右室及心包;弥漫大B细胞型是最常见的病理类型;临床表现无特异性;最常见的心电图异常表现为窦性心动过速;超声表现为：病灶多较大,累及范围广,常多个部位同时受累,内部回声以低回声或等回声为主,形态多不规则,与正常组织分界不清,活动度小,可导致瓣膜梗阻及合并不同程度心包积液,沿心外膜表面延伸并浸润心房或心室壁、瓣膜可被浸润但不受侵袭破坏、以及血管漂浮征是心脏淋巴瘤的超声特征。结论 心脏淋巴瘤患者临床表现缺乏特异性,其心脏超声表现具有一定特征性。超声心动图检查在患者早期诊断、治疗过程及缓解后的随访中可动态观察心脏肿瘤变化,为临床提供重要信息。     

彩色多普勒超声心动图评价法洛四联症术后小冠状动脉-右心室瘘

目的应用彩色多普勒超声观察法洛四联症术后小冠状动脉右室瘘的发生率，探讨其发生机制并评价其预后。方法接受法洛四联症根治术患者40例，根据其狭窄部位不同分为：右室漏斗部狭窄(伴有或不伴有肺动脉狭窄)35例，单纯肺动脉狭窄5例。比较术前及术后1周内彩色多普勒超声检查结果，观察术后发生的小冠状动脉-右室瘘，并随访其转归。结果40例患者中共7例术后发现小冠状动脉右室瘘，发生率17．5％。7例患者术前均存在右室漏斗部的肌性狭窄，而5例单纯肺动脉狭窄患者术后无小冠状动脉右室瘘发生。随访中，3例患者小冠状动脉右室瘘在术后3个月内消失，其余4例在半年内消失，7例患者均无其他并发症发生。结论法洛四联症术中切除右室肥厚心肌患者，术后部分会出现小冠状动脉-右室瘘，其对心内血流动力学无明显影响。彩色多普勒超声心动图是评价法洛四联症患者术后小冠状动脉右室瘘的敏感方法。     

Clinical and hemodynamic correlation in patients with pericardial effusion and swinging heart by echocardiography

The clinical and hemodynamic findings in 13 consecutive patients with “winging heart” on M-mode echocardiography were analyzed. In these patients the anterior right ventricular and posterior left ventricular walls and interventricular septum moved almost parallel to each other throughout the cardiac cycle, often with exaggerated excursion. In 10 of 13 patients right heart catheterization revealed the hemodynamic profile of cardiac tamponade, while one additional patient was found to have evidence of cardiac compression at the time of surgery. In the remaining two patients no acute invasive diagnostic procedures were performed. During the same observation period cardiac tamponade was observed in five patients without echocardiographic evidence of a swinging heart, and four of these had large clots in the pericardial space. Thus, the swinging heart pattern appears to be a reliable marker of cardiac tamponade, except in those patients with intrapericardial lesions which mechanically limit cardiac motion.     

Clinical features of cardiac lymphoma: an analysis of 37 cases

ObjectiveTo summarize the clinical and pathological features of patients with cardiac lymphoma.MethodsThe general conditions, clinical features, pathological types, and prognostic indices of 37 patients with cardiac lymphoma treated in our hospital were analyzed.ResultsAmong the 37 patients, only one had primary cardiac lymphoma, and the other 36 patients had secondary cardiac lymphoma. The cardiac manifestations were mainly chest tightness, shortness of breath, increased heart rates, and electrocardiographic abnormality caused by pericardial effusion, but myocardial enzyme levels were normal in all patients. Only three patients displayed solid heart-occupying manifestations. These lesions were mainly located in the right atrium, and the masses were all larger than 5 cm. The pathological type was diffuse large B cell lymphoma that did not arise from the germinal center in all three patients.ConclusionsCardiac lymphoma was mostly secondary, and pericardial effusion was the primary objective sign. Moreover, cardiac lymphoma was characterized by a high international prognostic index, late stage, and high rates of T and NK cell lymphoma. Most cases were accompanied by serous cavity effusion, extranodal involvement of important organs, elevated lactate dehydrogenase levels, hypoalbuminemia, and normal myocardial enzyme levels.     

The heart in rheumatoid arthritis--a clinical and echocardiographic study

A clinical and echocardiographic study was carried out in a randomly selected group of 101 patients with rheumatoid arthritis to determine the prevalence of cardiac abnormalities. Adequate two-dimensional assessments were obtained in 84 patients and 77 patients had adequate M mode recordings. Thirty-one patients (37 per cent) had 45 echocardiographic abnormalities. Five patients (6 per cent) had a pericardial effusion. Eleven abnormalities of the mitral valve were noted in 10 patients (13 per cent). Three patients had mitral valve prolapse, one patient with aortic incompetence had flutter on the mitral valve, five patients had mitral annular calcium and one patient had hypertrophic obstructive cardiomyopathy and mitral annular calcification. A reduction in the E-F slope was noted in 12 patients, seven of whom had associated cardiac disease, one patient had a sinus tachycardia and four patients (5 per cent) had a mild reduction without any other cardiac abnormality. Apart from the presence of pericardial effusion in 6 per cent and minor abnormalities of the E-F slope in 5 per cent of patients, all the other significant echocardiographic abnormalities could be related to the presence of associated cardiac disease.     

特殊临床表现的椎管内外巨大哑铃型神经鞘瘤诊断学特征

目的探讨特殊临床表现的椎管内外生长的巨大哑铃形神经鞘瘤诊断与治疗方法。 方法回顾研究暨南大学第二临床医学院2011年3月至2013年7月,以非脊柱疾病首诊入院的7例具有特殊临床表现的神经鞘瘤患者的诊疗过程及治疗方法与疾病转归。 结果7例患者中,分别首诊于泌尿外科2例、肝胆外科1例、妇科2例、疼痛科1例、理疗科1例,经会诊或进一步检查后纠正诊断。7例患者中,5例伴有不同程度的椎管内神经受压症状,2例无明显椎管内神经受压症状,影像学检查提示神经源性肿瘤可能,后行瘤体切除术,术后病理检查为神经鞘瘤。术后平均随访1.3年,患者症状消失,未出现复发和新发症状。 结论部分椎管内外生长的哑铃型神经鞘瘤有其特殊的临床表现,以腹部肿物压迫为初始症状,而椎管内神经受压症状出现较迟,临床医师应考虑到此病的可能性并进行进一步的检查,以便及早正确诊断。椎管内外联合包膜外切除术是治疗神经鞘瘤的有效方法。     

原发性肝淋巴瘤的诊断(附7例报告)

目的 探讨原发性肝淋巴瘤(PHL)的诊断方法。方法 回顾性分析7例手术病理诊断为原发性肝淋巴瘤患者的临床特点和超声等影像学表现。结果 PHL的主要临床表现为肝区胀痛或上腹不适(4例)，肝肿大(3例)；血清乙肝二对半阳性者5例，曾患肝炎5例，其中慢性肝炎或肝硬化4例；均无发热及外周淋巴结肿大；超声声像图除1例外均表现为低回声病灶，CT表现为低密度占位，二维超声和彩色多普勒超声共误诊为良性病变1例次、血管瘤4例次，误诊率为62．5％(5／8)；CT误诊为血管瘤或炎症性病变3例次，误诊率50％(3/6)；MRI误诊为血管瘤1次，误诊率50％(1/2)。结论 原发性肝淋巴瘤临床及超声等影像学表现无特异性，确定诊断必须依靠组织学检查及免疫组织化学测定。在声像图上表现为非常见的原发性肝癌及肝血管瘤等典型声像图或图像类似肝转移性肿瘤但无原发肿瘤存在时，应注意与之鉴别。     

Large pericardial effusion after cardiac surgery: role of echocardiography in diagnosis and management

We performed M-mode and two-dimensional (2-D) echocardiograms prospectively in 140 patients an average of eight days after open heart surgery. Large pericardial effusions occurred in 13 patients; three had complete circumcardiac pericardial effusion, four had local anterior adhesions, five had extensive anterior adhesions (posterior loculated effusion), and one had a large loculated pericardial effusion contiguous to the right atrium. In five patients with tamponade, the effusion was drained, with immediate reversal of symptoms and signs of tamponade. In the other eight patients, who had no deterioration in cardiovascular status, the effusion was not drained; instead, these patients were treated medically with indomethacin and observed with serial echocardiograms, and the effusions eventually disappeared. The most consistent echocardiographic differences between the five patients with and the eight patients without tamponade were that patients with tamponade had larger posterior pericardial effusions, more severe left atrial compression, and more indentation of the right atrial wall. Echocardiography plays an essential role in diagnosis and management of large pericardial effusions after open heart surgery. Patients with large pericardial effusions who are clinically stable need only medical management, including serial echocardiograms, but drainage is indicated if the cardiovascular or respiratory status worsens. Certain echocardiographic findings indicate a high probability of tamponade.     

右位主动脉弓胎儿超声心动图诊断分析

目的总结右位主动脉弓胎儿超声心动图表现及其血管特征.方法对26例超声心动图诊断为右位主动脉弓胎儿的超声心动图表现进行总结分析并观察其临床结局.结果26例右位主动脉弓胎儿中12例为孤立右位主动脉弓,2例为双主动脉弓,2例合并永存左上腔静脉,7例合并法洛四联症,3例合并永存动脉干.26例右位主动脉弓胎儿超声心动图均在上纵隔三血管气管观作出诊断.其中21例为右位主动脉弓合并迷走左锁骨下动脉、左位动脉导管,形成围绕气管食管的“U”字形血管环;2例双主动脉弓形成围绕气管食管的“O”字形血管环;3例无上述典型超声心动图图像特征.26例中12例活产儿经产后超声心动图或X线检查证实为右位主动脉弓;2例双主动脉弓经外院胎儿磁共振检查证实为右位主动脉弓;10例合并复杂先天性心脏病的胎儿均引产(6例尸体解剖检查证实为右位主动脉弓,4例未行尸体解剖检查);2例失访.结论胎儿右位主动脉弓有特征性超声表现,上纵隔三血管气管观可作为诊断胎儿右位主动脉弓的主要切面观;右位主动脉弓可孤立存在或同时合并其他心脏畸形.     

The Heart in Rheumatoid Arthritis -a Clinical and Echocardiographic Study

A clinical and echocardiographic study was casrried out in arandomly selected group of 101 patients with rheumatoid arthritisto determine the prevalence of cardiae abnormalities. Adequatetwo-dimensional assessments were obtained in 84 patients and77 patients had adequate M mode recordings. Thirty-one patients(37 per cent) had 45 echocardiographic abnormalities. Five patients(6 per cent) had a pericardial effusion. Eleven abnormalitiesof the mitral valve were noted in 10 patients (13 per cent).Three patients had mitral valve prolapse, one patient with aorticincompetence had flutter on the mitral valve, five patientshad mitral annular calcium and one patient had hypertrophicobstructive cardiomyopathy and mitral annular calcification.A reduction in the E-F slope was noted in 12 patients, sevenof whom had associated cardiac disease, one patient had a sinustachycardia and four patients (5 per cent) had a mild reductionwithout any other cardiac abnormality. Apart from the presenceof pericardial effusion in 6 per cent and minor abnormalitiesof the E-F slope in 5 per cent of patients, all the other significantechocardiograp hic abnormalities could be related to the presenceof associated cardiac disease.