Lipoma of the right atrium

A 66-year-old asymptomatic woman was admitted to our hospital with the diagnosis of a right atrial mass detected on an outside transthoracic echocardiogram and confirmed on transesophageal echocardiography. Physical examination and basal electrocardiogram were normal. Transthoracic echocardiography revealed a 3.8 x 2.5 cm echogenic mass in the right atrium. A multislice CT examination demonstrated a right atrial mass with a fat density ranging from -80 to -110 HU. The patient had a successful surgical excision of the mass, and the diagnosis of lipoma was confirmed on histopathological examination.     

Coronary arterial malformation depicted at multi-slice CT angiography

We present a case of a 57-year-old woman with an unremarkable medical history except for a continuous cardiac murmur at the left second and third interspaces. Transthoracic echocardiography revealed an unusual chamber in front of the heart. To evaluate the precise anatomy of this abnormality, multi-slice computed tomographic (MSCT) imaging was performed. MSCT angiography with retrospective ECG gating showed a coronary arterial malformation with fistulous communications to the coronary artery, pulmonary artery and the root of aorta. Images from MSCT coronary angiography can be helpful in understanding the tortuous configuration of the coronary arterial malformation.     

多层螺旋CT、内镜诊断胃脂肪瘤的效能分析

[目的]探讨多层螺旋CT(MSCT)及内镜检查诊断胃脂肪瘤的效能.[方法]本院收治的疑似为胃脂肪瘤的患者46例,经手术病理证实33例为胃脂肪瘤,13例为胃淋巴瘤.所有患者均于术前行内镜及MSCT检查.观察胃脂肪瘤MSCT及内镜检查及病理学检查表现;运用受试者工作特征曲线(ROC)分析内镜及MSCT诊断胃脂肪瘤的效能.[...     

Hiatal hernia presenting as a left atrial mass

Cardiac masses pose diagnostic challenges. We present a 62‐year‐old woman presented for evaluation of chest pain and palpitations. Transthoracic echocardiography showed left atrial mass, which was subsequently identified as hiatal hernia by cardiac magnetic resonance imaging.     

Localization of angiosarcoma by peri-operative transesophageal echocardiography

Transthoracic echocardiography (TTE), computed tomography (CT) and magnetic resonance (MR) cannot always clearly identify angiosarcoma. A 22 year old woman presented with dyspnea. Preoperative TTE showed no tumor, and CT and MR both gave the impression that an extra-cardiac, mediastinal tumor was present. Transesophageal echocardiography (TEE), performed during surgery showed an intra-cardiac tumor, which was a well-delineated mass at the intra-ventricular groove of the right heart and surrounding the superior vena cava. The tumor was excised and found to be a malignant angiosarcoma. TEE provides diagnostic advantages over other cardiac imaging techniques and can serve as a useful adjunct during and before intrathoracic surgery.     

Anomalous origin of the right coronary artery mimicking aortic dissection at transesophageal echocardiography

Transesophageal echocardiography (TEE) is the most common imaging modality for the detection of acute aortic syndromes. However anomalous anatomic structures may be occasionally misunderstood as pathologic due of lack of familiarity with anatomical variations; false-positive diagnosis can result, potentially leading to unnecessary surgical intervention. It is crucial for echocardiographers to be aware of possible pitfalls which may create false positive findings, since the complementary use of other imaging modalities, such as multislice spiral computed tomography (MSCT), could improve the diagnostic accuracy of TEE. We report a case in which an image resembling an acute aortic dissection (AAD) on transthoracic (TTE) and transesophageal echocardiography was found in a patient with acute chest pain; MSCT detected an anomalous origin of the right coronary artery as cause of false aortic dissection image at echocardiography.     

Cardiac lipoma in a patient with proven arrhythmogenic right ventricular dysplasia: a case report

Arrhythmogenic right ventricular dysplasia (ARVD) and primary cardiac tumours are rare conditions among heart diseases. In this case report we present an 18-year-old woman with ventricular tachycardia and intracardiac mass originating from interventricular septum. Clinical and pathological evaluation led to the diagnosis of invasive intramyocardial lipoma originated in an ARVD background. To our knowledge, this is the first case with a huge intramyocardial lipoma developed in a patient with ARVD.     

Tissue characterization of an unusual right atrial mass by magnetic resonance imaging

In a 70-year-old man who had angina, exercise-induced ventricular tachycardia, and presyncopal symptoms, transthoracic and transesophageal echocardiography disclosed a large atrial mass that resembled a myxoma. Subsequent evaluation by magnetic resonance imaging identified the mass as an intracardiac lipoma attached to the posterior wall of the right atrium, a diagnosis that was confirmed by surgical intervention. Thus, the diagnostic utility of magnetic resonance imaging as an adjunct to echocardiographic evaluation of intracardiac masses was demonstrated.     

Echocardiographic Diagnosis of a Right Coronary Artery-Coronary Sinus Fistula

In this case report, we describe a 67-year-old woman with right coronary artery-coronary sinus fistula. This woman had complaints of chest pain. Ischemic ECG changes and a ventricular tachycardia were detected on her electrocardiogram. Transthoracic echocardiography showed a large right coronary artery and a dilated coronary sinus. Drainage of the coronary artery to the coronary sinus was detected by colour flow mapping during transesophageal echocardiographic examination, and a 94 mmHg peak gradient was recorded by continuous wave Doppler at the drainage site. These findings were confirmed by cardiac catheterization. Transthoracic and transesophageal echocardiography can provide definitive confirmation of the right coronary artery-coronary sinus fistula, and can be the diagnostic procedure of choice when this anomaly is suspected.     

心脏黏液瘤多模态成像特点及诊断模式

目的 探究心脏黏液瘤(CM)多模态成像特点及其多模态诊断模式.方法 回顾性研究2016年7月至2019年8月在阜外医院行二维经胸超声心动图检查初诊为CM的178例患者,以病理结果为金标准,将研究对象分为CM组和非CM组,根据超声心动图特点将CM组划分为典型CM组和非典型CM组.分析归纳各组患者的临床特征,二维经胸超声心...     

Left atrial tamponade: diagnosis by transesophageal echocardiography

A 60-year-old white man became hypotensive and dyspneic 3 days after right pneumonectomy for bronchogenic carcinoma. Transthoracic echocardiography was nondiagnostic because of technical difficulty. Transesophageal echocardiography demonstrated a loculated posterior pericardial effusion with isolated diastolic left atrial collapse. The hemodynamic disturbance resolved after drainage of the effusion. Transesophageal echocardiography plays a valuable role in the diagnosis of postoperative cardiac tamponade.     

Feasibility of remote echocardiography with satellite transmission and real-time interpretation to support medical activities in the austere medical environment.

Echocardiography is an essential tool in the evaluation of patients with cardiac emergencies and chest trauma. The objective of our study was to establish the feasibility and diagnostic accuracy of a portable satellite transmission system in the assessment of cardiac emergencies for the real-time support of mass casualty and humanitarian relief efforts. Twelve patients with various degrees of cardiac structural disease identified by conventional inhospital transthoracic echocardiography were transported to a remote portable field hospital where transthoracic echocardiography was performed with a handheld echocardiographic device. Images were then relayed by a commercial satellite to a level III trauma center where they were interpreted in real time by a cardiologist. Remote studies were recorded at the field hospital before satellite transmission and again on download at the receiving facility. The remotely acquired studies before and after satellite transmission were compared with each other and subsequently compared with conventional hospital transthoracic echocardiograms for technical quality and diagnostic accuracy using a blinded, single-reader, side-by-side comparison. Excellent agreement was found between the recorded field-site and satellite-transmitted images with an overall average of 95% concordance. When the field data acquired with the handheld device and satellite transmission were compared with conventional inhospital echocardiography, a high degree of agreement was demonstrated in overall technical quality (83%) and assessments of left ventricular ejection fraction (100%), pericardial effusion (100%), and left ventricular size (92%). This study demonstrates the feasibility and diagnostic accuracy of remote, real-time echocardiography using satellite transmission for mass casualty triage or humanitarian relief efforts.     

超声心动图对心肌淀粉样变的诊断价值

目的 探讨心肌淀粉样变的超声心动图特征.方法回顾分析本院1994～2007年确诊的15例原发性淀粉样变心脏受累患者的超声心动图检查结果.结果 15例心肌淀粉样变患者均有不同程度的室间隔增厚(＞1.3 cm),11例患者左室后壁增厚(＞1.1 cm),8例房间隔增厚(＞0.6 cm).室间隔及左室游离壁心肌回声明显增强,分布不均匀,呈"毛玻璃样"改变,并可见散在颗粒样斑点状强回声.双房增大,左室射血分数减低,舒张功能受损,伴有少量心包积液.结论超声心动图能对心肌淀粉样变进行初步定性诊断和鉴别诊断.     

肾周肿瘤的CT诊断价值

目的:探讨肾周肿瘤的CT诊断价值。方法:搜集经手术或活检病理证实肾周肿瘤8例,回顾性分析其CT特征。结果:脂肪肉瘤(LS)4例,表现为肾周混杂密度肿块,3例以脂肪密度为主,内见条、片及团块状软组织影,增强后实质部分强化,1例以实体为主,内见多发散点状钙化,肾实质撑开呈新月状,肾盏扩大积水;脂肪瘤2例,表现为肾周脂肪密度肿块,杂有纤维条索。恶性纤维组织细胞瘤(MFH)1例,表现为左肾周混杂密度肿块,内见大块状钙化,肿瘤侵犯肾皮质、腰大肌、腰方肌及腹后壁,脾门及胰头周围多发钙化性转移结节,肝、肺及左侧胸膜转移。平滑肌肉瘤1例,表现为左肾周不规则软组织肿块,境界不清,强化不匀,侵及腰大肌及肾实质。结论:CT可清晰显示肾周肿瘤部位、密度及其与邻近组织的关系,对脂肪瘤、分化良好的LS及有钙化MFH的定性诊断具有重要价值。     

探讨MSCT对成人肠套叠的诊断价值

目的:探讨MSCT对成人肠套叠的诊断价值。方法:回顾性分析28例经手术证实的成人肠套叠患者的临床资料及MSCT影像资料;其中13例行CT平扫,另15例行CT平扫并增强检查,所有患者均采用薄层多平面重组(MPR)等技术进行图像后处理。结果:28例中继发肠套叠26例,原发肠套叠2例;病因分别为:结肠癌10例,淋巴瘤5例,脂肪瘤4例,小肠息肉3例,小肠错构瘤伴中度不典型增生1例,小肠血管肉瘤1例,胃术后粘连1例,大肠溃疡性病变1例;原发病术前CT检出率为96%(25/26),其中行增强检查患者的原发病灶检出率为100%。按套入部类型分:小肠-小肠型、回-结肠型、结-结肠型,分别为9例、8例、11例。28例病人的MSCT征象表现为:靶环征、彗星尾征、杯口征、双管征及肾形肿块等征象。结论:MSCT能清楚显示肠套叠征象,增强扫描有助于其病因的检出。     

Giant interatrial septal aneurysm mimicking a right atrial tumor

We report the case of a patient with a giant interatrial septum aneurysm who was admitted to our hospital for analysis of palpitations. Transthoracic echocardiography was not contributive and cardiac magnetic resonance imaging demonstrated a small interatrial septal aneurysm. In our study, only transesophageal echocardiography provided the correct diagnosis, showing a giant interatrial septal aneurysm protruding far away into the right atrium and mimicking a right atrial cystic tumor.     

Spontaneous left atrial echocardiographic contrast in mitral stenosis: early disappearance after valve replacement.

We describe a patient with mitral stenosis and severely enlarged left atrium. Transthoracic echocardiography showed a false image of intraatrial thrombus, whereas transesophageal echocardiography showed massive spontaneous left atrial contrast. Intraoperative transesophageal echocardiography was performed. During cardioplegic arrest the contrast was enhanced, but it gradually and completely cleared 15 minutes after cardiopulmonary by-pass arrest. Transesophageal echocardiography is a useful technique for the study of intraatrial masses and may bring a new dimension to tissue characterization studies.     

经胸超声心动图在诊断感染性心内膜炎中的应用

目的 评价经胸超声心动图诊断感染性心内膜炎的价值。方法 回顾性分析114例感染性心内膜炎患者的经胸超声心动图特征及临床资料,观察心脏瓣膜形态结构、活动及对合功能,寻找赘生物,观察瓣周结构及有无基础心脏病变。结果 114例患者中,104例以发热为首发症状,69例有基础心脏病,5例有全身性疾病。血培养阳性35例。超声示累及二尖瓣46例、主动脉瓣48例、三尖瓣17例、肺动脉瓣1例、人工瓣膜9例,其中多瓣膜受累7例;存在严重并发症19例。59例接受手术患者中,56例检出赘生物,术前超声诊断正确,诊断正确率为94.92%（56/59）。结论 经胸超声心动图可准确诊断感染性心内膜炎。     

Improved Echocardiographic Delineation of Left Ventricular Thrombus with the Use of Intravenous Second-Generation Contrast Image Enhancement

Transthoracic echocardiography is the most widely used diagnostic test for left ventricular (LV) thrombus, which must be distinguished from other intraventricular structures and image artifacts. To determine whether second-generation intravenous echocardiographic contrast agents provide better delineation of LV thrombus, we reviewed the results of 2-dimensional echocardiographic studies that were performed in 409 patients over a 1-year period to detect LV thrombus. Studies of 190 (46%) patients were interpreted as nondiagnostic for this purpose, of which 48 patients underwent an additional study after intravenous injection of 0.5 to 2 mL of human albumin microspheres within 1 to 4 days. In 43 (90%) of these 48 patients the contrast-enhanced study was definitive and diagnostic for either the presence or absence of an LV thrombus (P <.0001). Of the initial total of 409 patients, 81 had been studied at the bedside in intensive care units. The bedside studies were nondiagnostic for LV thrombus in 51 (63%) of these 81 patients. Of these 51 patients, 14 underwent additional imaging with contrast enhancement, and the contrast-enhanced images became diagnostic (P =. 004) in 11 (79%) of them. Thus intravenous contrast image enhancement improves the diagnostic yield of echocardiography in patients in whom initial images are nondiagnostic for LV thrombus.     

血清同型半胱氨酸对心脏结构和功能影响的研究

目的探讨血清同型半胱氨酸水平对心脏结构与功能的影响。方法研究对象包括冠心病患者57例,平均年龄(58±8)岁和正常人组24例,平均年龄(55±9)岁,均经选择性冠状动脉造影证实。应用HPSonos5500型超声诊断仪测定并计算舒张末期室间隔厚度、左室后壁厚度、舒张末期左室内径、左室心肌重量、左室重量指数和左室射血分数等指标。血清同型半胱氨酸水平应用高效液相色谱法测定。结果冠心病患者组同型半胱氨酸水平明显高于正常对照组〔（17.06±4.54)μmol/LVS(7.89±3.21)μmol/L,P＜0.01〕。舒张末期室间隔厚度、左室后壁厚度、舒张末期左室内径和左室心肌重量在两组间无显著性差异,而射血分数冠心病患者则明显低于正常人。舒张末期室间隔厚度、左室心肌重量和左室重量指数与血清同型半胱氨酸水平也呈显著正相关(r分别为0.25,0.36,0.32,P均＜0.05),而射血分数则与血清同型半胱氨酸水平呈显著负相关(r＝－0.36,P＜0.01)。结论研究表明血清同型半胱氨酸水平与舒张末期室间隔厚度、左室心肌重量和左室重量指数呈显著正相关,是影响心血管结构和功能的一个重要危险因素。