肺动脉吊带的超声心动图误诊分析

Analysis of misdiagnosis for echocardiography on pulmonary artery sling

目的分析肺动脉吊带的超声心动图误诊原因,探讨超声心动图检查对本病的诊断价值。方法以我院2006年10月至2010年2月经增强CT检查及手术治疗证实的25例肺动脉吊带患儿为研究对象,回顾性分析其超声心动图检查结果。结果 25例肺动脉吊带患儿均因呼吸道症状来我院就诊,经超声心动图检查确诊18例、疑诊2例、误诊5例。确诊的18例患儿超声心动图检查显示肺动脉分叉消失,主肺动脉直接延续为右肺动脉,于右肺动脉发出异常起源的左肺动脉,诊断正确率为72.0%(18/25)。2例疑诊患儿是因肺部疾患影响透声窗导致观察受限。误诊的5例患儿中有3例为肺动脉吊带合并动脉导管未闭,超声心动图检查仅诊断出动脉导管未闭而漏诊肺动脉吊带;余2例为肺动脉吊带合并右旋心,超声心动图检查误诊为右肺动脉缺如。25例患儿中单纯肺动脉吊带6例,合并其他心血管畸形19例。25例患儿均伴有不同程度气道受压,有明显气道狭窄的23例。结论超声心动图检查可早期确诊肺动脉吊带,多切面扫查肺动脉分叉及左右分支走行,可减少本病的误诊。

Objective To analyze the causes of misdiagnosis by echocardiography on pulmonary artery sling and evaluate the diagnosis value of echocardiography.Methods A total of 25 cases with pulmonary artery sling who confirmed by computer tomography and surgical operations from October,2006 to February,2010 were enrolled.Results All the 25 children with pulmonary artery were enrolled with respiratory symptoms.Eighteen confirmed cases,2 suspected cases and 5 misdiagnosis cases were taken by echocardiography.The disappearance of branch of pulmonary artery was presented in the 18 confirmed cases,and the left pulmonary artery was observed to rise from the right pulmonary artery by echocardiography.The accuracy rate of diagnosis was 72.0%（18 /25）.The reason for the 2 suspected cases was limitation of observation caused by the lung diseases.As to the 5 misdiagnosis cases,3 of them had combination of pulmonary artery sling and patent ductus arteriosus,while the patent ductus arteriosus was just diagnosed by echocardiography without pulmonary artery sling.The other 2 cases were combination of pulmonary artery sling and dextroversion,which was misdiagnosed as right pulmonary artery absence by echocardiography.Six cases of the 25 children were single pulmonary artery sling,and the other 19 were combined with other cardio-vascular malformation.All the 25 children had tracheobronchial compression at different levels,and 23 of them had apparent tracheobronchial stenosis.Conclusion The pulmonary artery sling at the early phase was diagnosed by echocardiography.The misdiagnosis can be decreased by detecting pulmonary artery branch and the route for the left and right pulmonary artery.