应用血管造影鉴别诊断误诊为巴德-吉亚利综合征的隐匿性缩窄性心包炎

目的探讨应用血管造影技术鉴别诊断误诊为巴德-吉亚利综合征的缩窄型心包炎患者。 方法回顾性分析378例以"巴德-吉亚利综合征"为早期诊断的病例,对所有病例均进行常规血管造影检查和术中测压。 结果在所有病例中有5例患者血管造影检查显示下腔静脉和肝静脉管腔通畅,但压力明显高于正常,右心房压力也明显高于正常,定期随访1～24个月,这5例患者均发现不同程度心包钙化,最终进行心包部分或全部剥离术。病理结果:结核性心包炎4例,化脓性心包炎1例,支持缩窄型心包炎诊断。 结论缩窄性心包炎部分临床病例症状不典型易误诊,建议有条件单位可应用血管造影技术进行下腔静脉、肝静脉、心脏各房室造影和测压明确有无上述血管疾患。

Applications of angiography in differential diagnosis of misdiagnosis as Budd-Chiari syndrome of occult constrictive pericarditis

ObjectiveTo evaluate the value of angiography in differential diagnosis of constrictive pericarditis, misdiagnosed patients with Budd-Chiari syndrome. MethodsA retrospective analysis was performed in 378 patients who were early diagnosed as Budd-Chiari syndrome, for all patients had underwent angiography and intraoperative manometry conventionally. ResultsThere were 5 cases showed inferior vena cava and hepatic venous lumen patency, but its pressure along with right atrial pressure significantly higher than the normal. During 1 to 24 months follow-up, these 5 patients were finally performed part or all of pericardium dissection due to the different degrees of pericardial calcification. Pathological findings: 4 tuberculous cases and 1 purulent case, they supported for diagnosis of constrictive pericarditis. ConclusionsIt is proposed that conditional units should perform inferior vena cava, hepatic vein and atrioventricular cardiac angiography and manometry for discriminating associated vascular disease.