超声对心上型肺静脉异位引流的诊断价值及其漏误诊原因分析

目的探讨超声对心上型完全性和部分性心上型肺静脉异位引流(TAPVC、PAPVC)的诊断价值,并分析其漏误诊原因。方法回顾性分析204例TAPVC、98例PAPVC患者的彩色多普勒超声图像特征,并与CT或手术对照,分析超声诊断的准确率及合并的畸形。结果204例心上型TAPVC,超声诊断准确率为100%,其中193例汇入头臂静脉,11例直接开口于右上腔静脉;202例显示完整4支肺静脉,仅2例显示3支肺静脉;主要合并的畸形有房间隔缺损165例(80.9%)、卵圆孔未闭34例(16.7%)。98例PAPVC,诊断准确率75.5%(74/98),其中60例引流入头臂静脉,37例汇入右上腔静脉,1例经奇静脉汇入上腔静脉;单支71例,两支21例,三支6例;合并的常见畸形有房间隔缺损67例(68.4%)、卵圆孔未闭15例(15.3%);误诊11例(11.2%),漏诊13例(13.3%),包含引流支数漏判9例和诊断漏判4例。结论超声对PAPVC的诊断准确率不及TAPVC。通过全面扫差异常血管走行,加强伪像及正常或异常心内结构的鉴别诊断有助于降低漏误诊率。

Diagnostic value of ultrasound for supracardiac anomalous pulmonary venous connection and causes of missed diagnosis and misdiagnosis analysis

Objective To explore the diagnostic value of ultrasound for supraventricular total and partial pulmonary venous connection(TAPVC,PAPVC),and analyze the causes of misdiagnosis and missed diagnosis.Methods The characteristics of color Doppler ultrasonography on 204 cases with TAPVC and 98 cases with PAPVC were retrospectively analyzed,the accuracy of diagnosis and the combined malformations were analyzed by compared with CT or surgery.Results The accuracy of ultrasound diagnosis of 204 TAPVC cases was 100%.193 cases were transferred to the brachiocephalic vein,11 cases were directly open to the right superior vena cava.202 patients showed complete pulmonary veins,only 2 patients showed 3 pulmonary veins.Combined malformations included 165 cases(80.9%)of atrial septal defect,34 cases(16.7%)of patent foramen ovale.Among 98 cases of PAPVC,the accuracy of ultrasound diagnosis was 75.5%(74/98).60 cases were introduced into the brachiocephalic vein,37 cases were directly transferred into the right superior vena cava,and 1 case was transferred into the superior vena cava via azymatic vein.There were 71 cases of single,21 cases of two,and 6 cases of three.Combined malformations included 67 cases(68.4%)of atrial septal defect,15 cases(15.3%)of patent foramen ovale.11 cases were misdiagnosed and 13 cases were missed diagnosed,including 9 cases of missed judgment of drainage count and 4 cases of missed diagnosis of diagnosis.Conclusion The accuracy of ultrasound in the diagnosis of PAPVC is weaker than that of TAPVC.By comprehensively scanning abnormal blood vessel contours and enhancing the differential diagnosis of artifacts and normal or abnormal intracardiac structures,it can help to reduce the rate of missed diagnosis.