心脏肿瘤—病理与超声表现

心脏原发性良性肿瘤多位于心肌层(含心内膜)内侧缘,房、室间隔;根据瘤体部位,边界,包膜,回波性质,(竹帝),活动与否及形态变化,可对其性质作一大致鉴别。心脏原发性恶性肿瘤、转移性肿瘤多位于心肌层(含心外膜)外侧缘、心包,呈孤立或多灶性,心包积液或心包渗出～缩窄并存,少数为心腔内肿块。     

胎儿心脏横纹肌瘤的超声诊断及直系亲属临床特征分析

目的:探讨胎儿超声心动图结合直系亲属患病特征,在产前诊断心脏横纹肌瘤并评估其预后的临床价值。方法:回顾性分析2007年至2014年,我科诊断为心脏横纹肌瘤的9例胎儿超声心动图特征,应用二维及多普勒超声探查心脏肿瘤发生部位、数目、大小、形态及相应血流动力学变化,同时记录家族相关病史及临床特征。结果:检出胎儿心脏肿瘤(考虑胎儿心脏横纹肌瘤)9例,1例自孕31周首检发现后随访至出生后37个月;8例选择终止妊娠,其中1例经病理证实为心脏及心包膜多发性横纹肌瘤,其父系有结节性硬化症症状和体征;4例直系亲属有结节性硬化症相关症状和体征;无结节性硬化症家族史者3例。超声心动图均显示为心腔内的中高回声团块,2例因流出道梗阻引起血流速度加快,1例伴有过缓。结论:心脏横纹肌瘤常是最早发现结节性硬化症的重要征象。重视直系亲属相关症状、体征是产前诊断心脏横纹肌瘤的有力依据。     

51例心脏原发性肿瘤的超声评价

对 51例心脏原发性肿瘤进行回顾性分析 ,其中 4 2例为左房粘液瘤 (82 .4 % ) ,6例为右房粘液瘤(11.9% ) ,1例为左室横纹肌瘤 (1.96 % ) ,2例为右室纤维肉瘤 (3.92 % ) ,全部病例均做心脏超声检查 ,符合率10 0 % ,被认为是确诊本病的首选及最佳方法。本文同时对心房粘液瘤瘤蒂长短、活动度大小、基底部宽窄与手术时间及方法选择的关系 ,各种肿瘤最佳切面观察进行了讨论。     

心脏肿瘤的临床和超声诊断—附23例报告

心脏肿瘤的临床表现无特异性 ,其诊断极为困难 ,多数被误诊为风湿性心脏瓣膜病、心包炎、先天性心脏病等。又因继发性心脏肿瘤的发病率较低 ,而被临床忽视。本文报道 2 3例超声心动图诊断的心脏肿瘤 ,其中原发性 14例 ,继发性 9例 ;经手术、病理或临床证实 2 0例。1　资料和方法2 3例患者年龄 4 2～ 82岁 ;男 13例 ,女 10例。仪器 :AL OKA- SSD- 870和 HP- IP型彩色超声仪 ,探头频率为 2 .0～ 3.5MHz,用二维取心脏各切面观察肿瘤的部位、轮廓、大小、形态 ,回声强度 ,活动度 ,并作 CDF1,Dopp1er等检查和综合分析。2　结　果2 .1　肿…     

原发性心脏肿瘤的超声诊断价值与分析

目的探讨原发性心脏肿瘤的超声心动图特征与临床诊断价值。方法回顾性分析我院62例原发性心脏肿瘤患者的临床资料,将超声检查结果与手术病理结果对照。结果术前超声心动图对54例黏液瘤做出正确诊断;1例右室黏液瘤及良性非黏液性肿瘤、恶性肿瘤均提示相应部位占位性病变。黏液瘤多位于左房,有蒂,多附着于房间隔,活动度大,包膜完整,与心肌分界清,少复发;而恶性肿瘤多无蒂,活动度小,包膜不完整,与心肌分界不清,易复发。结论超声心动图对原发心脏肿瘤的诊断与鉴别诊断具有较大的价值。     

900例胎儿超声心动图诊断胎儿先天性心脏病的体会

目的　探讨胎儿超声心动图对胎儿期先天性心脏病的诊断方法及应用价值。方法　 1989年 11月～ 2 0 0 0年 11月对 90 0名高危孕妇行胎儿超声心动图检查。孕妇年龄 2 2～ 39岁 (2 7 9岁± 3 9岁 ) ,孕期 2 0～ 42周 (33 4周± 4 8周 )。首先应用二维超声心动图 (2DE)探察 ,横切胎儿胸部取标准四腔切面作为基础切面 ,旋转探头方向获取五腔心、大动脉短轴、左室长轴、主动脉弓长轴、下腔静脉长轴等切面 ,在清晰的切面图像上叠加彩色多普勒信号 ,观察心内有无异常血流 ;以脉冲多普勒记录主、肺动脉瓣及二、三尖瓣血流频谱或异常湍流频谱。结果　胎儿期先天性心脏病发病率3 78% (34 / 90 0 ) ,胎儿超声心动图诊断胎儿先天性心脏病的敏感性 92 %、特异性 95 %、阳性预测值 91%、阴性预测值96 %。结论　胎儿超声心动图诊断胎儿先天性心脏病的敏感性、特异性高 ,为妇产科及儿科医生提供有价值的资料 ,应作为高危孕妇的常规检查     

胎儿心脏定量分析技术在中孕晚期正常胎儿心脏结构及功能的研究

目的：用定量分析技术（fetal heart quantification,Fetal HQ）,对中孕晚期正常胎儿心脏结构及功能等参数进行初步分析。方法：收集2019年9月至2020年1月,在北京安贞医院母胎医学中心就诊的,妊娠22～27周间的153例正常单胎妊娠胎儿,进行系统超声心动图检查,存储胎儿标准四腔心切面,通过Fetal HQ软件后处理操作计算出心脏整体及左、右心室不同节段的球形指数（sphericity index,SI）,左、右心室24节段舒张末期内径及短轴缩短分数（fractional shortening,FS）、左、右心室面积变化率（left and right ventricular area change rate, FAC）及整体纵向应变（global left and right ventricular longitudinal strain,GLS）和LVEF并探讨各参数数据分布情况及与孕周之间的相关性。并进行检查者间和检查者自身的重复性检验。结果：除左心室1～24节段LVEDD及右心室第4～13节段舒张末期内径（right ventricular dia...     

胎儿超声心动图

胎儿超声心动图是超声心动图学的新领域,对先天性心脏病的产前诊断具有重要意义。本文系统介绍了胎儿超声心动图的检查指证、胎儿二维和多普勒超声心动图的特征和临床应用。     

婴幼儿原发性心脏肿瘤超声心动图诊断分析

目的探讨超声心动图在婴幼儿原发性心脏肿瘤诊断中的应用价值。 方法选取26例疑似原发性心脏肿瘤婴幼儿,均行超声心动图检查,完善相关检查后,经手术或穿刺活检明确诊断,分析超声心动图对原发性心脏肿瘤的诊断价值。 结果26例疑似心脏肿瘤患儿中,1例确诊为原发性心脏肿瘤,属心脏黏液瘤(良性);25例确诊为心内膜炎,其中19例伴瓣膜赘生物。超声心动图诊断2例原发性心脏肿瘤,其中1例为心内膜炎赘生物误诊为心脏肿瘤,诊断敏感度为100.0%,特异度为96.0%,与病理诊断符合率为96.15%。 结论超声心动图诊断婴幼儿原发性心脏肿瘤具有较高敏感度,可为临床正确诊断提供客观依据,有利于治疗方案的制定与实施。     

Primary cardiac non-Hodgkin's lymphoma diagnosed by transthoracic echocardiography

Primary cardiac lymphomas are extremely rare and can be diagnosed by echocardiography. We present the case of a 79-year-old man with an intracardiac mass, shown to be an aggressive large B-cell lymphoma by mediastinal aspiration, who had rapid regression of the tumor following one cycle of chemotherapy.     

A primary benign cardiac tumor misdiagnosed as cardiac metastasis in the right atrium

We present a patient with breast cancer with multiple metastases who had an unusual cardiac mass in the right atrium. The cardiac mass was initially diagnosed as malignant metastasis by transthoracic echocardiogram (TTE) but subsequently diagnosed as benign by contrast-enhanced ultrasonography, cardiac magnetic resonance imaging (MRI), and positron emission tomography/computed tomography (PET/CT). TTE is the preferred imaging method for examination of cardiac masses. However, this case demonstrates that contrast-enhanced ultrasonography, MRI, and PET/CT are useful to differentiate between diagnoses of benign and malignant tumor. The combination of multiple diagnostic imaging modalities is necessary to confirm the diagnosis of cardiac tumors.     

节段分析法在胎儿先天性心脏病超声诊断中的临床应用

目的探讨节段分析法（segmentalanalysis）在胎儿先天性心脏病（CHD）超声诊断中的临床应用价值。方法回顾性分析2010年6月至2011年11月应用节段性分析法超声检查出的26例心脏畸形胎儿,其中简单型先天性心脏病（室间隔缺损、房间隔缺损）10例,复杂型先天性心脏病16例。结果26例心脏畸形胎儿中,出生后彩超证实5例（室间隔缺损4例、房间隔缺损1例）,误诊1例（产前诊断为膜周型室间隔缺损,产后彩超证实为右冠状动脉右室瘘）,其余心脏畸形胎儿经随访及省级医院超声复查证实后作引产处理。结论节段分析法在胎儿心脏超声检查中能系统地分析心脏结构异常,对于提高简单型先天性心脏病诊断准确度价值不大,对于复杂型先天性心脏病能提供更准确、更完善的诊断结果,对于妊娠筛选及产后干预有重要临床指导意义。     

Advanced cardiac imaging techniques assist in characterizing a cardiac mass and directing management

Advanced imaging techniques, including contrast echocardiography and CMR, provided valuable characterization and evaluation of a boy with an unusual cardiac mass. Imaging features assisted with differentiation of benign from malignant etiology and excluding thrombus. Accurate imaging techniques saved our patient risks associated with unnecessary surgery or anticoagulation. The ability to accurately define size serially assisted in guiding expectant management. He died from a noncardiac cause at age 28, and autopsy demonstrated a hamartoma of mature cardiac myocytes.     

Primary cardiac angiosarcoma: A case report

Cardiac angiosarcomas are the most common primary malignant cardiac tumors in adults. The diagnosis is often delayed due to nonspecific clinical symptoms at presentation. The cornerstones of diagnosis are echocardiography and the histological evaluation of the cardiac biopsy. The knowledge on the treatment is limited; the outcomes of chemotherapy, radiotherapy, complete surgical removal, and heart transplantation are controversial. We report a 38‐year‐old woman with a primary heart tumor which infiltrated the right atrial wall and the pericardium and caused pericardial effusion. Angiosarcoma was verified histologically. The surgical excision could not be radical, and the patient died 3 months from diagnosis.     

Echocardiographic features of primary cardiac sarcoma

Primary cardiac sarcoma is extremely rare and seldom causes symptoms until late in its course. Discomfort may occur only when the mass causes obstruction to the intracardiac flow. Early diagnosis is vital because it allows prompt and relevant management. We describe the history and echocardiographic features in four patients with primary cardiac sarcoma and review the current literature.     

Transthoracic echocardiographic features of cardiac pheochromocytoma: a single-institution experience

Background: Cardiac pheochromocytoma is extremely rare. Previous papers usually are reports of a single case. Transthoracic echocardiography (TTE) offers a useful option, but the features of cardiac pheochromocytoma on TTE have not been favorably reported. In this study, the findings of cardiac pheochromocytoma on TTE in nine cases were presented. Methods: TTE images (especially two‐dimensional ultrasound) of nine patients with cardiac pheochromocytomas were analyzed retrospectively and compared with the findings from surgery. Results: Among the nine patients with cardiac pheochromocytomas identified in Peking Union Medical College Hospital (PUMCH) clinical and echocardiographic database, TTE identified one cardiac tumor in seven cases (77.8%), two cardiac tumors in one case (11.1%), and a false‐negative result in another (11.1%). Cardiac pheochromocytomas were usually located on the base of the heart, near the origin of great arteries. The tumors were usually round or ovoid, ranging from 1.4 cm to 7.7 cm in diameter, with homogeneous and moderate echoes and low activity. They could press or invade surrounding cardiac structures and influence hemodynamics. In this study the majority of cardiac pheochromocytoma seemed marginated and appeared to be encapsulated on TTE. Apical four‐chamber view and parasternal short‐axis view of the aortic valve were most effective in identifying cardiac pheochromocytomas. The findings on TTE were similar to those from surgical procedures. Conclusion: Cardiac pheochromocytomas presented characteristic TTE appearances in aspect of location, size, texture, and shape of tumors. Understanding of these characteristics on TTE can help correctly recognize this extremely rare disease. (Echocardiography 2012;29:153‐157)     

Combined transthoracic echocardiography and contrast‐enhanced ultrasonography to trace intravenous leiomyomatosis with intracardiac extension

Intravenous leiomyomatosis (IVL) with intracardiac extension is a rare condition, which the benign tumor invades into the right heart through inferior vena cava. We described the findings of ultrasonography in eight patients with this disease. Transthoracic echocardiography (TTE) can reveal the intracardiac lesion burden and associated compromise. Contrast‐enhanced ultrasonography (CEUS) can trace the origin of the lesion and extension. Therefore, combining TTE with CEUS is used to better characterize this complex lesion and plays a crucial role in guidance of surgical decision.