磁共振咸像（MRI）对心包囊肿诊断的意义

目的：探讨MRI对心包囊肿诊断的优势及特异性。方法：采用日本东芝公司MRT-50A型超导全身磁共振成像装置，收集1995-2000年问6例磁共振诊断心包囊肿病例进行磁共振分析。结果：6例病例中5例囊肿位于右心膈角区，1例位于左心缘，1例术后诊断为心包憩室。讨论：MRI的软组织对比分辨率最高，可以直接显示心包。对水样物质或脂肪组织既敏感又特异，因此，MRI在心包囊肿的诊断及鉴别诊断中具有很高的敏感性及特异性。     

经心包腔处理肺血管在肺切除术中的意义

目的：探讨经心包腔解剖与结扎肺血管在肺癌病人行肺切除术中的临床意义。方法：对32例中央型肺癌的病人采用经心包腔解剖与结扎肺动脉和／或肺静脉的方法行全肺或肺叶切除术。结果：32例病人手术过程顺利，术中肺血管无损伤，无大出血。结论：经心包腔解剖与结扎肺血管是一种安全而有效的方法，可提高肺癌病人的手术切除率。     

心包病变的CT诊断

报告44例心包病变的CT表现，其中包括心包积液、心包增厚、肿瘤直接侵犯心包及心包钙化。用CT检查心包病变，快速准确，无创伤。可以弥补心脏超声检查和某些不足。特别是对于局灶性心包积液，心包不规则增厚及钙化、肿瘤侵犯心包等为其它检查方法所不及。本组病例中，50%以上为肺癌患者，肺癌的心包转移、应引起临床注意。     

介入性超声在心血管疾病诊治中的应用

一、心包穿刺术B超引导心包穿刺术是一项简便、安全、直观的技术赔于推广。它克服了传统心包穿刺的盲目性和危险性，临床主要用于：（1）心包抽液，以确定积液的性质，解除心包填塞；（2）置管引流，以对心包腔反复冲洗，多次注药治疗，起到外科手术心包切开引流的作用；（3）心包活俭及心包开窗术。过去心包活检手术需要在全身麻醉下开胸进行，创伤较大。借助二维超声心动图导向施行经皮穿刺心包活俭，并对反复出现心包积液的病人进行心包胸膜腔开窗术，对部分心包炎、心包肿瘤的病因和病理诊断有重要意义。根据本院开展超声引导监测心包…     

彩色多谱勒超声引导心包积液穿刺临床价值

目的：探讨彩色多谱勒引导心包积液穿刺价值。方法：回顾分析29例心包积液经彩超引导穿刺抽液、生化及脱落细胞检查证实的临床资料，分析心包积液声像图与穿刺抽液的临床价值。结果：29例心包积液均穿刺成功，疾病不同，心包积液颜色性质可不同，心包积液量不等，穿刺体位、方法可不同。结论：经彩超引导心包积液穿刺抽液具有准确，安全等优点，是诊断心包积液性质方法之一。     

超声引导下穿刺置管治疗心包积液56例

心包穿刺置管是治疗心包积液的有效手段之一,同时可对心包积液的性质进行判定。采用超声引导下心包穿刺可提高穿刺成功率,减少并发症。2008年1月-2013年2月,我们采用超声引导下S型一步法穿刺置管引流治疗心包积液56例,效果满意。现分析报告如下。     

急性主动脉夹层并心包积血的CT所见

80％主动脉夹层的死亡原因是由于破裂,其中破入心包者达70％。作者报道了主动脉夹层并发心包积血的CT特征。对象是Stanford A型急性主动脉夹层并发心包积血者,共35例,年龄24～81岁,其中男19例,女16例。假腔血流状态为假腔开放者21例,血栓闭塞者14例。在CT上观察心包积血的分布、CT值、有无心外膜下血肿及纵隔血肿。将心室周围心包腔比较宽的腔隙分为右室前面的前心包     

慢性风湿性心脏病心包组织的研究

采用ＨＥ、ＶＧ病理染色、透射电镜、原子吸收光谱测定、组织羟脯氨酸测定及蛋白电泳技术研究先天性心脏病和慢性风湿性心脏病心包组织病理、钙含量、胶原含量及Ⅰ、Ⅲ型胶原比值的变化，以探讨利用先心病及风心病人心包组织制作自体包生物瓣膜的可行性。     

经皮穿刺心包闭式引流术的护理

经皮穿刺心包闭式引流术的护理林平，赵丽娟，王锐对于心包积液的治疗过去均采用反复心包穿刺排液和外科心包引流术的方法。我院自１９９２年８月起采用经皮穿刺心包内置管闭式引流的方法治疗心包积液患３２例，均取得满意疗效。现将其护理体会介绍如下。１临床资料本组患...     

缩窄性心包炎120例X线分析

本文收集我院资料较完整的缩窄性心包炎120例，就其X线表现作一分析，这120例的诊断依据；（1）作心包剥离术94例，其中有病理结果81例；（2）心包切开引流术10例，经心包穿刺，抽出心包液体10例；3．有明确心包钙化4例，经心导管检查及尸检证实各1例。     

CT of intracardiac and intrapericardial masses

Computed tomographic (CT) equipment capable of high-resolution, rapid-sequence scanning allows detection of intracardiac and intrapericardial masses. Two patients with intrapericardial masses (pheochromocytoma, organized hematoma) and three patients with intracardiac masses (right ventricular rhabdomyosarcoma, right atrial metastasis, and left atrial thrombus) are presented. CT is the imaging method of choice for displaying pericardial masses directly and may be superior to echocardiography and angiocardiography in the detection of ventricular thrombi. In patients with cardiac tumors, CT evaluates extent of disease including invasion of contiguous vessels and pulmonary metastases better than echocardiography. Dynamic scanning after bolus intravenous injection of contrast material is recommended for the evaluation of patients with suspected masses involving the heart or pericardium.     

CT diagnosis of congenital intrapericardial masses

Prior to the development of CT, cardiac and pericardiac masses were evaluated by chest roentgenography, angiocardiography, and echocardiography. In most cases preoperative diagnosis of a specific entity was impossible. Preoperative CT diagnosis of an intrapericardial developmental mass becomes possible because of the presence of fat, fat/fluid level, thick walled cysts, as well as globular calcifications, bones, teeth, water density fluid, and soft tissue. A report of a young woman with a ruptured and infected intrapericardial teratoma and an infant with an intrapericardial bronchial cyst is presented.     

Intrapericardial installation of radioactive chromic phosphate in malignant effusion.

Treatment of 28 patients with malignant pericardial effusion was accomplished primarily by intrapericardial instillation of radioactive chromic phosphate. At time of diagnosis of pericardial disease, 14 patients had major manifestations of tamponade; the rest had little or no clinical evidence of effusion. Only eight of the 28 patients had further problems with effusion after the initial pericardiocentesis and 32P instillation. Additional aspirations were done on those patients 2 weeks to 5 months later. The average survival was 9 months; seven patients lived more than 1 year.     

Computed tomography of pericardial masses: further observations and comparison with echocardiography

Eight patients with surgically proven primary intrapericardial masses were evaluated over the past 3 years using a variety of radiologic tests. Dynamic CT prospectively identified the masses in all eight patients, esophagography was positive in four of five patients, chest radiography was prospectively positive in one of eight patients, and echocardiography identified a mass in only one of seven patients. Furthermore, precise CT localization of the masses proved important in surgical management of these patients, suggesting in several instances the need for cardiopulmonary bypass. Although echocardiography is the modality of choice in evaluating potential pericardial effusion, CT should be the preferred diagnostic test for suspected intrapericardial mass lesions.     

Cardiac herniation and volvulus: radiographic findings

Cardiac herniation with volvulus is a catastrophic complication of right intrapericardial pneumonectomy. This case illustrates diagnostic radiographic findings that may be essential for early diagnosis and survival, since the clinical signs are nonspecific.     

MR imaging of an intrapericardial pheochromocytoma

The magnetic resonance (MR) appearance of an intrapericardial pheochromocytoma is reported, and the role of MR, compared with CT and a 131I-metaiodobenzylguanidine scan in delineating masses from cardiac and vascular structures in the mediastinum is discussed.     

CT and MR evaluation of pericardial and retrosternal adhesions after cardiac surgery

The visibility of the pericardium as well as of the space between the dorsal aspect of the sternal surface and the pericardial surface after cardiac surgery was determined by CT and/or MR with electrocardiographic (ECG)-gated spin-echo (SE) and gradient-echo sequences. Seventeen patients who had undergone cardiac operations and who were admitted for cardiac reoperation were investigated with CT and/or MR prior to sternal reentry. Five patients were investigated with CT alone, ten with both CT and MR, and two with MR only. At reoperation, retrosternal adhesions were classified as present or absent, and intrapericardial adhesions were classified as absent, minimal, moderate, or severe. A similar classification was applied to the CT and MR findings. In 14 of 15 patients, the CT findings were in agreement with those found at operation regarding postoperative retrosternal extrapericardial adhesions in the cranial retrosternal space and in 12 of 15 in the caudal retrosternal space. Computed tomography could not detect intrapericardial adhesions. Magnetic resonance was sensitive to metal artifacts from sternal sutures in both sequences and could therefore not be used to detect postoperative retrosternal extrapericardial adhesions. On the other hand, MR with ECG-gated SE sequences confirmed intrapericardial adhesions in 44 of 57 locations.     

CT evaluation of enhancing mediastinal masses

The CT scans of 132 patients with mediastinal masses and CT scans from our teaching file were retrospectively reviewed to evaluate the role of contrast enhancement in limiting the differential diagnosis of a mediastinal mass. Ten patients with an enhancing mediastinal mass were found. Coupled with mass enhancement, location and hypertension were helpful in limiting the differential diagnosis. Four masses were of thyroid origin, and all were contiguous with neck thyroid. All patients with functioning paragangliomas were hypertensive and all intrapericardial enhancing masses were functioning paragangliomas. A normotensive patient had a nonfunctioning aortic body paraganglioma superiolateral to the aortic arch. An enhancing mass in a similar location in a hypertensive patient was a functioning paraganglioma. Castleman disease occurred posterior to the heart.     

A large intrapericardial cyst presenting as a cardiac abnormality.

A case of mitral regurgitation apparently caused by extrinsic pressure of the large intrapericardial cyst distorting the mitral valve is reported. The initial radiographic appearance of the cyst suggested an atypically enlarged left atrium. The mitral regurgitation subsided after surgical drainage of the cyst. The angiogram showed elevation of the right pulmonary artery and depression of the left atrium.     

Another look at the "ring-around-the-artery" in pneumomediastinum

Gas surrounding the right pulmonary artery has been observed in three patients, including two in whom it was demonstrated around the intrapericardial right pulmonary artery on frontal films. This would provide a pathway for occasional development of spontaneous pneumopericardium.