右心系统血栓和恶性肿瘤的超声心动图诊断经验分享  

The Experience in Diagnosis of Echocardiography of Right Heart Thrombus and Malignant Tumor

作　　者：陈爱红[1] 李爱莉[1] 翟亚楠 周宝风 高倩[2] 郑玉民[3] 林洁[4] Chen Aihong;Li Aili;Zhai Yanan;Zhou Baofeng;Gao Qian;Zheng Yumin;Lin Jie(Department of Cardiology,China-Japan Friendship Hospital,Beijing 100029,China;Department of Respiratory and Critical Care Medicine,China-Japan Friendship Hospital,Beijing 100029,China;Department of Nuclear Medicine,China-Japan Friendship Hospital,Beijing 100029,China;Department of Pathology,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院心脏科,北京市100029 [2]中日友好医院呼吸与危重症医学科,北京市100029 [3]中日友好医院核医学科,北京市100029 [4]中日友好医院病理科,北京市100029

出　　处：《中国超声医学杂志》2023年第4期396-399,共4页Chinese Journal of Ultrasound in Medicine

基　　金：首都卫生发展科研专项项目(No.首发2020-2-4063);中国医学科学院医学与健康科技创新工程(No.2021-I2M-1-049);国家临床重点专科建设项目(No.2020-QTL-009)。

摘　　要：目的探讨经胸超声心动图(TTE)及心脏超声造影对右心系统血栓和恶性肿瘤的诊断价值。方法回顾性分析过去6年间超声心动图报告右心系统占位性病变且经“金标准”证实占位性质的52例患者的临床和影像学资料。总结超声心动图在诊断及鉴别右心系统血栓和恶性肿瘤方面的价值。结果经“金标准”方法确诊血栓33例,占63.5%(33/52);恶性肿瘤19例,占36.5%(19/52)。超声心动图提示诊断与“金标准”结果相符46例,误诊1例,5例无法鉴别,其中10例通过心脏超声造影协助鉴别血栓与肿瘤。慢性血栓栓塞性肺动脉高压组与肺动脉肉瘤组比较,右心房、右心室扩大更明显,差异有统计学意义(P值分别为0.027、0.004)。结论超声心动图可明确右心系统占位性病变的形态学特点和血流动力学改变,结合病史及临床特征,能初步判断占位性质。心脏超声造影可以帮助进一步鉴别占位性质,增强诊断信心。Objective To evaluate the value of transthoracic echocardiography(TTE)and contrast echocardiography in the diagnosis of right heart thrombus and malignant tumor.Methods The clinical and imaging data of 52 patients with right heart occupying lesions reported by echocardiography in our hospital during the past 6 years and confirmed by the"gold standard"were retrospectively collected and analyzed.We summarized the value of echocardiography in the diagnosis and differentiation diagnosis of right heart thrombi and malignant tumors.Results Among the 52 cases,33 cases(63.5%,33/52)were thrombi based on the"gold standard",while 19 cases(36.5%)were malignant tumors.Echocardiography provided diagnosis consistent with the"gold standard"in 46 cases,misdiagnosis in 1 case,and undifferentiated in 5 cases.Among the 46 cases,contrast echocardiography was used in 10 cases to assist in differential diagnosis of thrombus and tumor.Compared with the pulmonary artery sarcoma group,right atrial and right ventricular enlargement were more obvious than those in the chronic thromboembolic pulmonary hypertension group(P=0.027,0.004,respectively).Conclusions Echocardiography can identify the morphological characteristics and hemodynamic changes of right heart occupying lesions.Combining with the clinical features,it can preliminarily determine the nature of the masses.Contrast echocardiography can help to further determine the nature of the mass and enhance diagnostic confidence.

关 键 词：超声心动描记术 血栓 肿瘤 心脏超声造影 

分 类 号：R540.45[医药卫生—心血管疾病] R541[医药卫生—内科学] R73[医药卫生—临床医学]