心力衰竭合并多囊性腹膜间皮瘤所致难治性腹腔积液1例  

Misdiagnosis and Misdiagnosis of Ascites Caused by Heart Failure with Polycystic Peritoneal Mesothelioma:A Case Report

作　　者：李东东 刘宝清[2] 仇欢 LI Dong-dong;LIU Bao-qing;QIU Huan(Department of Anorectal Surgery,Oriental Hospital,Beijing 101300,China;Beijing University of Chinese Medicine,Beijing 100078,China;Imaging Department of Dasungezhuang Health Center,Shunyi District,Beijing,Beijing 101300,China)

机构地区：[1]北京市顺义区空港医院外科,北京101300 [2]北京中医药大学东方医院普外科,北京100078 [3]北京市顺义区大孙各庄卫生院影像科,北京101300

出　　处：《中华养生保健》2024年第23期172-176,共5页CHINESE HEALTH CARE

摘　　要：目的探讨多囊性腹膜间皮瘤所致难治性腹腔积液的临床特点。方法对1例心功能Ⅳ级的多囊性腹膜间皮瘤病例资料进行回顾性分析。结果该例患者5年前冠状动脉支架术后出现阵发性喘憋,加重伴腹胀3月就诊,入院时双侧胸腔积液伴大量腹腔积液,超声心动提示“EF值23%”,其他检查暂未提示其他器质性及腹腔感染性疾病,考虑心源性腹腔积液。予以抗心力衰竭治疗后,症状缓解不明显,再次完善相关检查,发现腹膜多囊实性病变,确诊为“多囊性腹膜间皮瘤”。因患者全身耐受性极差,未予相关治疗,入院2个月后因循环衰竭死亡。结论腹膜间皮瘤发病罕见,缺乏特异性症状及检查,当心力衰竭反复出现难治性腹腔积液,并且用原发疾病心力衰竭无法进行合理解释时,应警惕腹膜间皮瘤的可能性,以免误诊误治。Objective To investigate the clinical characteristics and causes of misdiagnosis of refractory ascites caused by benign multicystic peritoneal mesothelioma.Methods A case of benign multicystic peritoneal mesothelioma with gradeⅣcardiac function was misdiagnosed retrospectively.Results This patient had paroxysmal dyspnea after coronary stenting 5 years ago,aggravated with abdominal distension,and went to the hospital for 3 months.At admission,bilateral pleural eff usion accompanied by a large amount of peritoneal eff usion.Echocardiography showed"EF value 23%".Other examinations did not indicate other organic and abdominal infectious diseases,and cardiac peritoneal eff usion was considered.After receiving anti heart failure treatment,the symptoms did not improve signifi cantly.Further examination revealed polycystic solid lesions in the peritoneum,which was diagnosed as"polycystic mesothelioma of the peritoneum".Due to poor systemic tolerance,the patient did not receive any relevant treatment and died of circulatory failure 2 months after admission.Conclusion The incidence of peritoneal mesothelioma is extremely low,lack of specifi c symptoms and examination.If refractory ascites can not be explained by the primary disease,the possibility of peritoneal mesothelioma should be alert,so as to avoid misdiagnosis.

关 键 词：多囊性腹膜间皮瘤 误诊 心力衰竭 腹腔积液 

分 类 号：R735.5[医药卫生—肿瘤]