左心室心尖部巨大纤维瘤合并T波倒置2例并文献复习

Giant fibroma of left ventricular apex with T wave inversion:2 cases report and literature review

目的探讨左心室心尖部巨大纤维瘤的临床特点、诊断方法及治疗方案。方法回顾性分析2例2020年9月和2022年5月在武汉亚洲心脏病医院确诊为左心室心尖部巨大纤维瘤患者的临床表现、心电图、影像学检查特点和治疗方案,并复习相关文献。结果2例患者均有活动后轻微胸闷不适,心电图均出现不同程度的T波倒置,分别误诊为“心肌炎”“冠心病”,心脏磁共振、超声心动图均显示左心室心尖部团块,冠状动脉造影检查未见冠状动脉狭窄病变。1例患者要求保守治疗,随访半年患者临床症状无明显变化,瘤体大小无变化;另1例患者行心脏肿块剥除术,术后病理检查证实为心脏纤维瘤,随访2年无复发。结论左心室心尖部纤维瘤是罕见的心脏肿瘤,容易漏诊、误诊,是T波倒置的少见原因之一。心脏磁共振、CT和超声心动图是诊断心脏纤维瘤的常用影像学检查手段,手术切除是一种有效的治疗方法。

Objective To investigate the clinical features,diagnostic methods and treatments of left ventricular apical fibroma.Methods The clinical manifestations,ECG,imaging features and treatment plans of 2 patients with giant fibroma of left ventricular apex diagnosed in September 2020 and May 2022 were analyzed retrospectively,and the related literature was reviewed.Results Both patients had slight chest distress and discomfort after activities.The ECG showed T-wave inversion of different degrees,which were misdiagnosed as“myocarditis”and“coronary heart disease”respectively.The cardiac magnetic resonance imaging and echocardiography showed left ventricular apical mass.Coronary artery stenosis was not found in coronary angiography.One patient required conservative treatment,and there was no significant change in clinical symptoms and tumor size in the follow-up for half a year;Another patient underwent cardiac mass removal,and the pathological examination after operation confirmed that it was cardiac fibroma,and there was no recurrence in the follow-up 2 years.Conclusion Fibroma of left ventricular apex is a rare cardiac tumor,which is easy to be missed and misdiagnosed,and is one of the rare causes of T-wave inversion.Cardiac magnetic resonance imaging,CT and echocardiography are commonly used imaging methods to diagnose cardiac fibroma,and surgical resection is an effective treatment.