原发性心脏肿瘤的影像学分析

目的分析原发性心脏肿瘤的影像学特点。方法11例经手术病理证实的原发性心脏肿瘤，包括左房黏液瘤7例，右房黏液瘤1例，右室黏液瘤1例，右房黏液肉瘤1例，心房纤维肉瘤1例，分析其胸片（正侧位或心脏常规片11例）、超声心动图（11例）、多层螺旋CT（2例）影像学表现，与手术所见及病理对照。结果胸部平片能观察房室增大及肺血改变9例，其中7例左房黏液瘤中6例均有不同程度肺淤血及左房右室增大，3例右心肿瘤均有肺血减少及右房右室增大，其中1例右房黏液肉瘤、1例右室黏液瘤并有肺动脉段突出；超声心腔团块状回声11例，肿瘤腔内房室定位、附着处、腔内病灶大小正确11例，其中黏液瘤9例见瘤蒂，活动度大，2例恶性肿瘤活动度小，9例粘液瘤均符合病理诊断；多层螺旋CT空间分辨率及密度分辨率高于超声，1例左房黏液瘤显示心房内附着于房间隔的类椭圆密度不均肿块，1例右房黏液肉瘤可观察到肿瘤侵及右房后壁。结论原发性心脏肿瘤超声心动图、胸片、多层螺旋CT的表现各有一定的特点。     

超声心动图在心房黏液瘤诊断和分型中的应用

目的探讨心房黏液瘤的超声特点及新的分型方法的临床意义,评价超声心动图在心房黏液瘤诊断中的应用价值。方法回顾分析182例心房黏液瘤经胸及经食管超声心动图表现并按附着部位分型,术后观察复发情况。结果本研究中,典型黏液瘤占78．02％,不典型黏液瘤占21．98％。14例在行经胸超声心动图漏诊或显示不佳的情况下,行经食管超声心动图检查均显示清晰。心房黏液瘤形态偶见长条形,瘤体内可见钙化样、纤维化样强回声,囊状无回声,偶可见血流信号。不典型黏液瘤复发率明显高于典型黏液瘤（P〈0．05）。结论经胸超声心动图是术前诊断和术后随访心房黏液瘤的主要检查手段,当经胸超声心动图诊断不明确时,经食管超声心动图可以作为心房黏液瘤较好的辅助检查方法。     

心脏黏液瘤31例超声诊断及误诊分析

目的研究彩色多普勒超声心动图对心脏黏液瘤的诊断价值。方法对31例心脏黏液瘤进行超声心动图检查,采用心脏超声常规切面。结果 31例心脏黏液瘤患者中均在不同心腔内探及类圆形偏强回声团。结论超声心动图是诊断本病的首选检查方法 。     

彩色多普勒超声诊断心脏黏液瘤的临床价值及准确性分析

目的:探究心脏黏液瘤患者应用彩色多普勒超声诊断的价值。方法:此次研究对象选择2000例疑似心脏黏液瘤患者,且研究时间均开始于2019年1月,终结于2020年12月,本院对纳入患者均行彩色多普勒超声诊断,并以手术病理结果为金标准,分析彩色多普勒超声诊断的准确性。结果:手术病理结果中,纳入患者确诊心脏黏液瘤40例,其中右心房黏液瘤12例、左心房黏液瘤28例,瘤体最大体积为7.54cm×5.45cm×3.87cm,瘤体最小体积为2.02cm×1.39cm×1.11cm。超声诊断诊出病症39例,其中右心房黏液瘤11例、左心房黏液瘤27例,右心房黏液瘤患者可见胸骨左缘3-4肋间明显杂音,且右侧卧位更为清晰;而左心房黏液瘤患者可见心尖区杂音,且左侧卧位更为清晰。超声诊断病症诊出率、肿瘤形态、瘤蒂特征与手术病理结果比较(P>0.05)。结论:心脏黏液瘤患者应用彩色多普勒超声诊断效果显著,可有效反映患者瘤体形态、体积、瘤蒂特征等信息,为临床诊治提供科学依据,值得推广。     

左房黏液瘤的X线与超声诊断(附10例分析)

目的 :探讨左房黏液瘤的X线平片诊断和超声诊断价值。材料与方法 :本组 10例 ,男性 4例 ,女性 6例。均采用心脏常规位片及超声心动图检查 ,并手术病理证实。结果 :10例左房黏液瘤的X线平片特点 :(1)左房增大与心脏增大不相一致。 (2 )左房、右室和肺动脉段的改变不成比例。 (3)左房增大与肺郁血、肺循环高压的程度不相称。超声心动图特点 :(1)收缩期心房内可见云雾状光团回声。 (2 )二尖瓣前叶呈城墙样改变 ,舒张期光团随血流移入二尖瓣口。结论 :根据左房黏液瘤的临床及X线表现特点 ,平片可以提出可能性诊断 ,但超声心动图是最精确、可靠、简便、安全的诊断。     

超声心动图在心房肿瘤中的诊断价值

目的分析心房肿瘤的超声心动图表现及手术、病理结果,探讨超声心动图对不同类型心房肿瘤的诊断价值。方法回顾性分析我院手术治疗的592例心房肿瘤患者的临床资料及超声心动图表现,所有病例均经手术和病理证实。结果 (1)592例心房肿瘤中良性肿瘤最多,共559例(94.4%),其中黏液瘤最多见(540例,91.2%);原发恶性肿瘤22例;转移性肿瘤11例。(2)心房黏液瘤超声诊断符合率达96.3%,具有典型超声心动图特征。(3)本研究资料中发现8例心内平滑肌瘤病患者,该病患者均为女性,均有子宫肌瘤或行子宫切除术病史,此病具有典型超声心动图特征。结论不同类型心房肿瘤具有不同的超声心动图特征,超声心动图对心房黏液瘤及心内平滑肌瘤病具有较高的诊断价值。     

左房黏液瘤的X与与超声诊断（附10例分析）

目的：探讨左房黏液瘤的X线平片诊断和超声诊断价值。材料与方法：本组10例,男性4例,女性6例。均采用心脏常规位片及超声心动图检查,并手术病理证实。结果：10例左房黏液瘤的X线平片特点：（1）左房增大与心脏增大不相一致。（2）左房、右室和肺动脉段的改变不成比例。（3）左房增大与肺郁血、肺循高压的程度不相称,超声心动图特点：（1）收缩期心房内可见云雾状光团回声。（2）二尖瓣前叶呈城墙样改变,舒张期光团随血流移入二尖瓣口。结论：根据左房黏液瘤的临床及X线表现特点,平片可以提高可能性诊断,但超声心动图是最精确、可靠、简便、安全的诊断。     

心房黏液瘤的超声诊断与临床价值

目的：总结46例心房黏液瘤超声诊断与临床价值。方法：回顾性分析46例心房黏液瘤病例术前超声诊断，术后资料对比，左房黏液瘤36例，右心房黏液瘤10例。结果：超声诊断心房黏液瘤具有简便、无创、准确、费用低等优点。外科临床医生往往是以超声检查为主要诊断依据直接手术。结论：超声是目前诊断心房黏液瘤最有临床价值的非创伤性检查方法，它不仅可以避免心导管和心血管造影检查所致栓塞的危险，而且可为临床上早期诊断及指导手术提供可靠依据。     

经胸心脏超声检查诊断心脏黏液瘤七例

目的了解经胸心脏超声检查对心脏黏液瘤的诊断价值。方法对7例心脏黏液瘤的位置、数目、大小、形状、瘤蒂附着点和活动度、瓣膜口梗阻情况等进行回顾性总结分析。结果经胸心脏超声检查共栓出左房黏液瘤6例,右房黏液瘤1例,均具有特征性的超声表现。结论经胸心脏超声检查对心脏黏液瘤具有较高的诊断价值,是诊断本病的首选检查方法。     

心房黏液瘤长时间延误诊治分析

目的探讨心房黏液瘤的临床特点及误诊原因。方法对我院收治的心房黏液瘤1例的临床资料进行回顾性分析。结果本例因突发右侧肢体无力伴言语不清1 h入院。1个月前曾因脑梗死住院治疗,根据脑梗死空间和时间的多发性及医技检查结果,病初诊断为多发性硬化,予对症治疗好转出院。1年后因突发晕厥、右侧肢体无力伴失语再次入院,心脏彩色多普勒超声示:左心房内可见附着于房间隔下部并随心脏搏动而运动的团块样肿物,约40 mm×30 mm,确诊为心房黏液瘤并行手术治疗。随访10年余,晕厥、右侧肢体无力未发作,遗留右侧肢体偏瘫伴不完全性混合性失语。结论心房黏液瘤临床表现复杂,提高认识并尽早行相关医技检查可避免或减少误诊误治。     

Left atrial myxoma associated with acute myocardial infarction

A 38-year-old male was admitted to our institution with left atrial myxoma complicated with acute myocardial infarction. The patient had no risk factor for coronary artery disease. A transthoracic echocardiographic study revealed the presence in the left atrium of an echogenic, mobile mass, compatible with myxoma. There were no endocrine hyperactivity, any other tumor and family history. Coronary angiography revealed normal coronary arteries and aorto-coronary bypass surgery was not required in this patient. The tumor was successfully removed surgically. In conclusion, there could be no other etiologic possibility identified and therefore left atrial tumor causing coronary embolization and MI was considered the most likely event in this patient.     

心房黏液瘤的外科治疗

目的总结心房黏液瘤的治疗经验,探讨心房黏液瘤的特点和外科疗效。方法回顾总结从2003年7月至2009年1月我院共手术治疗心房黏液瘤26例患者的临床资料,其中右房黏液瘤5例,左房21例,均在全麻低温体外循环下行心房黏液瘤切除术。结果全组近远期无手术死亡病例,无复发,无远期并发症。随访2～65月,平均随访46月。结论心房黏液瘤在心脏黏液瘤中最多见,多为良性,诊断右心房黏液瘤不要忽视转移瘤。心房黏液瘤手术效果好,确诊后应立即手术。     

心房黏液瘤合并动脉栓塞的CT表现与临床治疗

目的 探讨心房黏液瘤合并动脉栓塞的CT表现、临床治疗及疗效。方法 收集6例左心房黏液瘤合并动脉栓塞患者,均于完善包括冠状动脉及外周动脉CTA检查在内的相关检查后行手术治疗;对其CTA表现及临床资料进行回顾性分析。结果 6例心房黏液瘤均发生于左心房,CT平扫呈低密度,3例动脉期强化,蒂宽窄不等,1例伴有钙化;6例均伴有动脉栓塞,栓塞部位为髂动脉2例、 肱动脉1例、 股动脉2例和腹主动脉伴两侧髂动脉多发栓塞1例。采用同期或分次心房黏液瘤切除联合外周动脉Fogarty导管取栓术进行治疗,无死亡病例,术后患者肢体疼痛消失。随访6个月~2年,均无心房黏液瘤复发或取栓部位黏液瘤再发种植转移,受累肢体血运良好。结论 CTA可对心房黏液瘤合并动脉栓塞作出较全面的诊断;采用心房黏液瘤切除辅以栓塞动脉Fogarty导管取栓术进行联合治疗可获得满意疗效。     

Left atrial myxoma: phonocardiographic, echocardiographic, and micromanometric hemodynamic correlations

We used simultaneous echocardiography, phonocardiography, and high-fidelity micromanometry to investigate the impact of the movement of a large pedunculated left atrial myxoma on hemodynamics. The case we have described shows that (1) the early diastolic sound (tumor plop) coincided with maximal excursion of the tumor in the left ventricular inflow tract, (2) tumor movements during mid to late diastole corresponded to low-frequency oscillations in left ventricular pressure, (3) tumor expulsion from the left ventricle into the left atrium was initiated during "isovolumic" contraction but continued into the early ejection phase, (4) mitral valve closure was abnormally delayed until after the onset of aortic ejection, and (5) systolic ejection was initiated before coaptation of the mitral valve leaflets. These findings support the theory that tumor motion contributes to both systolic and diastolic vibrations of the entire cardiohemic system.     

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 .     

Left atrial myxoma mimicking papillary fibroelastoma

A 67-year-old woman was referred to our hospital with a diagnosis of deep vein thrombosis due to surgery for left patellar fracture. Deep vein thrombosis resolved with thrombolytic therapy. Transthoracic echocardiogram revealed a mobile left atrial tumor. Transesophageal echocardiography showed a fragile tumor with multiple fronds, implying a papillary fibroelastoma. Because this patient had a history of cerebral embolism, urgent surgery was scheduled. The excised tumor showed a sea anemone-like appearance in saline, which was similar to that of a papillary fibroelastoma. However, histological examination revealed the features of a myxoma and not papillary fibroelastoma. Herein, we illustrate a very rare case of left atrial myxoma with papillary fibroelastoma-like features in terms of both echocardiographic and gross findings.     

Echocardiographic features of right atrial thrombi

The clinical and echocardiographic features of six patients in whom a right atrial thrombus was detected using two-dimensional echocardiography are reported. In four patients with acute cor pulmonale, the thrombus appeared as a coiled mass moving freely within the right atrium and prolapsing through the tricuspid valve. In another patient referred for syncope, a large coiled mass attached to the lateral wall of the right atrium was seen prolapsing regularly through the tricuspid valve, simulating an atrial myxoma. In the remaining patient who presented with chronic cor pulmonale, two-dimensional echocardiography demonstrated a motionless ovoid mass with a broad base of attachment to the interatrial septum.     

Cardiac Myxoma: A Rare Case Series of 3 Patients and a Literature Review

Myxoma is the most common tumor in the heart. A typical myxoma is relatively straightforward to diagnose. However, certain cardiac myxomas have rare features. We report three extremely rare cases of cardiac myxoma. One case involved a myxoma that originated from the annulus of the tricuspid after valvuloplasty, one case involved myxomas associated with left atrial thrombus and severe mitral stenosis, and the third case involved myxoma combined with severe calcification. All three cases were diagnosed by echocardiography and pathology. We also review clinical presentations and diagnostic characteristics of cardiac myxomas.     

Pulmonary edema of an unexpected cause

Atrial myxoma is rarely seen in practice. We report a 67-year-old female who presented with acute cardiac insufficiency and pulmonary edema. Cardiac murmur was not detected on precordial examination. Urgent echocardiography, however, revealed atrial myxoma causing mitral valve obstruction. We point out that a normal cardiac examination does not exclude atrial myxoma. The diagnosis may be delayed until significant myocardial dysfunction occurs, as reported here. The clinical presentation of cardiac myxoma is discussed, along with appropriate investigations and treatment.     

颌骨牙源性粘液瘤的螺旋CT和MRI影像表现

目的：探究颌骨牙源性粘液瘤的螺旋CT及MRI的影像特征。 方法: 回顾性分析经病理证实的40例牙源性粘液瘤患者, 40例均行CT检查，其中11例行CT增强检查；5例行MRI检查，其中2例行MRI增强检查。观察40例的病灶部位、大小、内部结构、密度、信号、强化特点。 结果：40例中女22例（55%），男18例（45%），年龄10～66岁，平均（33.5±13.5）岁；上颌骨11例，下颌骨29例；临床表现为颌骨缓慢生长的无痛性肿块（29例 72.5%）；主要影像学表现：40例均呈膨胀性改变，2例呈局灶性骨质破坏。特征性表现为多房伴垂直或成角分隔（21例52.5%）,分隔朝向肿瘤周边。邻近牙齿脱落（18例45.0%）多见。CT增强上多数病灶可有边缘强化，MRI检查对病灶范围及成分的显示具优势。 结论：牙源性粘液瘤的CT表现具有特征性，联合MRI检查对颌骨OM病变诊断具重要意义。