急性心肌梗死后心肌夹层超声诊断误诊漏诊原因分析

Analysis of the cause of misdiagnosis and missed diagnosis in the ultrasound diagnosis of myocardial dissection after acute myocardial infarction

目的:探讨急性心肌梗死后心肌夹层超声误诊漏诊原因。方法:回顾性分析6例急性心肌梗死后心肌夹层患者超声心动图的诊断情况。结果:6例急性心肌梗死后心肌夹层的病例中超声确诊3例,漏诊2例,误诊1例。确诊3例中2例为急性心肌梗死累及前室间隔并发心肌夹层(1例合并室间隔穿孔),1例为急性心肌梗死累及左室下壁并发心肌夹层。漏诊2例中1例为急性心肌梗死累及前室间隔并发心肌夹层,1例为急性心肌梗死累及左室后壁及下壁并发心肌夹层伴室壁穿孔。误诊1例为急性心肌梗死累及下壁并发心肌夹层。结论:急性心肌梗死后并发心肌夹层罕见,以前对其认知不足从而不能把握超声诊断的要点,导致这种病易漏诊和误诊。

Objective：To discuss the cause of misdiagnosis and missed diagnosis in the ultrasound diagnosis of myocardial dissection after acute myocardial infarction.Method：We retrospectively analyzed the echocardiographic diagnosis of the 6 patients who suffered from myocardial dissection after acute myocardial infarction.Result：There were 3 patients diagnosed,2 patients miss diagnosed,and 1 patient misdiagnosed by echocardiography.There were2 patients of 3 diagnosed patients with acute myocardial infarction involving the anterior interventricular septum concurrented myocardial dissection.There was 1 patient of the 2 patients miss diagnosed with acute myocardial infarction involving the anterior interventricular septum concurrented myocardial dissection,and 1 patient with acute myocardial infarction involving inferior and posterior of the left ventricular concurrented myocardial dissection.There was 1 patient misdiagnosed with acute myocardial infarction involving the inferior of the left ventricular concurrented myocardial dissection.Conclusion：Myocardial dissection after acute myocardial infarction is rare.And we can grasp the main points of the echocardiographic diagnosis of the disease.