房间隔完整的肺静脉异位引流超声影像特征分析  

Diagnosis of Nomalous Pulmonary Venous Connection With Intact Interatrial Septum By Transthoracic Echocardiography

作　　者：张颖 弓文清 胥盼 牛义翠 刘莹 郑敏娟 Zhang Ying;Gong Wenqing;Xu Pan;Niu Yicui;Liu Ying;Zheng Minjuan(Department of Ultrasound,Xijing Hospital,Air Force Military Medical University,Xi’an,Shanxi 710032,China)

机构地区：[1]空军军医大学西京医院超声医学科,西安市710032 [2]空军军医大学西京医院放射科,西安市710032

出　　处：《中国超声医学杂志》2020年第10期895-898,共4页Chinese Journal of Ultrasound in Medicine

基　　金：陕西省国际合作项目(No.2015KW-049);空军军医大学第一附属医院助推计划(No.XJGX15Y16)。

摘　　要：目的探讨房间隔完整的肺静脉异位引流APVC病例超声影像资料,深化对该特殊类型疾病的认识,提高诊断率,避免漏诊。方法回顾性分析我院经CT血管造影(CTA)确诊为APVC的超声影像资料,共21例不合并房间隔缺损或卵圆孔未闭,分析其超声特征、诊断符合率、异位引流路径及合并畸形。结果房间隔完整的APVC病例中女性较多,首诊年龄为36 d^77岁。所有病例均为部分型,以心上型为主(76.2%,16/21),引流路径左侧多见(61.9%,13/21),主要为左侧1~2支肺静脉经垂直静脉-头臂静脉-上腔静脉入右房。与CTA结果对照,超声诊断符合率47.6%(10/21),继发表现为右房轻微增大,23.8%(5/21)合并轻度肺动脉高压。此类病例可不合并其他畸形或仅合并主动脉发育异常(23.8%,5/21)。结论房间隔完整的APVC以心上型多见,引流路径多在左侧。超声心动图作为APVC的常见首诊检查方法,对房间隔完整的APVC极易漏诊。对右心负荷增加者需重视肺静脉及头臂静脉扫查。主动脉发育异常者尤需警惕肺静脉回流部位,避免漏诊。Objective Analyzing the ultrasonography data of anomalous pulmonary venous connection(APVC)with complete atrial septum,and deepen the understanding of APVC,improving the diagnostic rate and avoiding misdiagnosis.Methods Retrospective analyzing the ultrasonography data of APVC with complete atrial septum diagnosed by CT angiography(CTA)in our hospital.A total of 21 cases were uncombined with atrial septal defect or patent foramen ovale,and the ultrasound characteristics,diagnostic rate,drainage pathway and combined malformations were analyzed.Results The APVC with complete atrial septum was common in female,and the age of first diagnosis ranged from 36 days to 77 years.All cases were partial APVC,mainly supra-cardiac(76.2%,16/21),and more in left(61.9%,13/21).The main drainage route was 1-2 left pulmonary veins go through the Vertical vein,brachiocephalic vein,Superior vena cava into right atrium.Compared with the CTA results,the coincidence rate of ultrasound diagnosis was 47.6%(10/21).The secondary manifestation were right atrium increased slightly,23.8%(5/21)with mild pulmonary hypertension,and 23.8%(5/21)without other malformations or only combined with aortic dysplasia.Conclusions The most common type of APVC with complete atrial septum is supra-cardiac and more in left side.Echocardiography as the common first diagnosis method for APVC,is easy to misdiagnosis for APVC patients with complete atrial septum.Patients with right heart load increased need pay more attention to scan the pulmonary vein and head brachial vein,and patients with abnormal aortic development need on high alert and avoid misdiagnosis.

关 键 词：肺静脉异位引流 房间隔完整 超声心动图 

分 类 号：R445.1[医药卫生—影像医学与核医学] R725.4[医药卫生—诊断学]