结核性心包积液的临床与影像学诊断(附29例分析)

Clinical and imaging diagnosis of tuberculous pericardial effusion

目的探讨结核性心包积液的临床与影像学诊断。方法29例临床上高度怀疑结核性心包积液(TPE)患者均经超声心动图和胸部X线检查。8例患者又经胸部CT研究。回顾性分析了全部患者的影像与临床资料。结果超声心动图证实了所有患者的心包积液伴胸腔积液及心脏疾患。X线(透视,胸片)发现18例心包与胸腔积液及3例肺结核。CT检查不但能发现全部患者的心包与胸腔积液,而且还发现了X线胸片上未显示的3例肺内云絮状钙化灶与3例心包壁增厚。29例患者中,最常见的症状是胸疼(100%),气急(41.4%),及心悸(24.1%)。心包液的实验室检验表明,ADA>45UL-1见于8例,TR-PCR阳性5例,PPD阳性10例。结论及时影像检查与临床资料的综合分析是早期确诊TPE关键性因素。

Objective To oxplore the clinical and imaging diagnosis of tuberculous pericardial effusion (TPE).Methods Twenty-nine patients with clinically highly suspected TPE underwent echocardiogram and chest X-ray examination. 8 patients underwent additional chest CT studies .Imaging modalities,clinical manifestations and laboratory test results in all patients were analyzed retrospectively. Results Echocardiogam directly demonstrated pericardial and pleual effusion in all patients.X-ray examinations of the chest revealed pericardial and pleural effusicn in 18 cases and pulmonary tuberculosis in 3 cases.CT studies of the chest could not only find pericardial and pleural effusion in all patients but found intrapulmonary cloud-form calcific foci in 3 cases and thickened pericardial wall in 3 cases,which were invisible on X-ray plain films .Among 29 patients ,the most common symptoms were chest pain(100%),dyspnea (41.4%) and palpitation (24.1%).The laboratory test of the pericardial fluid suggested that ADA was more than 45UL 1in 8 cases,positive-PCR in 5 cases and positive-PPD in 10 cases.Conclusion Timely imaging examination and overall analysis of clinical and imaging findings as well as test results are critical factors for early diagnosis of TPE .