经胸超声心动图对纵隔占位性病变的诊断价值

目的探讨纵隔占位性病变的超声特点,以提高早期诊断率。方法回顾性分析我院经胸超声心动图(TTE)检出并经病理或临床结合CT证实的纵隔占位性病变7例,扫查心脏左室长轴、胸骨上窝、剑下切面,重点观察心包周围、升主动动脉前方区域、降主动脉两侧和心脏后方。结果7例中,前纵隔占位4例;3例为囊性占位,分别为皮样囊肿、胸腺囊肿和肺癌并包裹性纵隔胸膜积液;胸腺囊肿及皮样囊肿均边界清,内部透声好。肺癌并包裹性胸腔积液形态欠规则,后壁可见松软低回声物质积聚。实性占位1例,为胸内甲状腺肿,边界清,呈实性不均质回声。后纵隔占位3例,其中神经纤维瘤1例,肝癌、肺癌并后纵隔转移各1例。神经纤维瘤呈中等回声的实质性团块,边界清晰,其内回声欠均匀;肝癌、肺癌并后纵隔转移边缘不规则,呈实性不均质团块回声。结论根据TTE检查切面的特点,结合纵隔占位的图像特征,提高TTE医师对纵隔内占位性病变的扫查意识,有助于纵隔内占位性病变的早期诊断和治疗方案的制定。

Diagnostic value of transthoracic echocardiography for mediastinal space-occupying lesions

Objective To explore the value of the ultrasonographic features of echocardiogra phy for mediastinal space-occupying lesions and provide references for early diagnosis.Methods Mediastinal space-occupying lesions in 7 cases were detected by echocardiography and confirmed by CT or pathology.Analyze the clinical symptoms and echocardiography features in order to guide the diagnosis.The suprasternal fossa subdivision section of the left ventricular axis of the heart was scanned,with the focus on the anterior region of the ascending active artery around the pericardium,both sides of the descending aorta and the posterior region of the heart.Results Among the 7 cases,anterior mediastinal space was occupied in 4 cases.There were 3 cases with cystic space occupying,which were dermoid cyst,thymoid cyst and lung cancer with enveloped mediastinal pleural effusion.Thymoid cysts and dermoid cysts have clear boundary and good sound transmission.Lung cancer with enveloping pleural effusion was irregular in shape,and the posterior wall showed the accumulation of soft hypoechoic material.Solid space occupying was found in 1 case,which was an intra-thoracic goiter with clear boundary and solid heterogeneous echo.Posterior mediastinal mass was found in 3 patients,including 1 case with neurofibroma,1 case with liver cancer,1 case with lung cancer with posterior mediastinal metastasis.Neurofibroma is a moderately echogenic mass with clear boundary and uneven internal echo.Hepatocellular carcinoma and lung cancer was with irregular posterior mediastinal metastasis margins and with solid heterogeneous mass echo.Conclusion According to the characteristics of section of echocardiography examination and the image characteristics of mediastinal space occupation,it is helpful to improve the echocardiography doctors′awareness of scanning mediastinal space occupation lesions,which is helpful to the early diagnosis and treatment of mediastinal space occupation lesions.