心房黏液瘤长时间延误诊治分析

Analysis of Delayed Diagnosis and Treatment of Cardiac Myxoma

目的探讨心房黏液瘤的临床特点及误诊原因。方法对我院收治的心房黏液瘤1例的临床资料进行回顾性分析。结果本例因突发右侧肢体无力伴言语不清1 h入院。1个月前曾因脑梗死住院治疗,根据脑梗死空间和时间的多发性及医技检查结果,病初诊断为多发性硬化,予对症治疗好转出院。1年后因突发晕厥、右侧肢体无力伴失语再次入院,心脏彩色多普勒超声示:左心房内可见附着于房间隔下部并随心脏搏动而运动的团块样肿物,约40 mm×30 mm,确诊为心房黏液瘤并行手术治疗。随访10年余,晕厥、右侧肢体无力未发作,遗留右侧肢体偏瘫伴不完全性混合性失语。结论心房黏液瘤临床表现复杂,提高认识并尽早行相关医技检查可避免或减少误诊误治。

Objective To explore the clinical features of cardiac myxoma(CM)and reasons for misdiagnosis.Methods A retrospective analysis of one patient with CM was performed.Results This patient was admitted to the hospital for sudden right limb hemiplegia accompanied by alalia.She was hospitalized 1 month before for cerebral infarction.Based on nature of multiple stroke at different places and time and results of medical examinations,she was preliminarily diagnosed as having multiple sclerosis(MS),and discharged with a better health condition after treatment.In the second year,the patient was rehospitalized with sudden dizziness and right limb weakness accompanied by aphasis.Color doppler echocardiography revealed a mass with 40mm×30mm in size attached to the atrial septum in the left atrium and pulsating with the heart.She was diagnosed as having CM,which was then surgically removed.During follow-up for over 10 years,she reported no dizziness or right limb hemiplegia,but right hemiplegia and incomplete mixed aphasia.Conclusion The clinical manifestations of CM are complex,therefore,improved understanding and early medical examinations can assist to avoid or reduce CM misdiagnosis.