心脏转移性肿瘤的超声心动图特征及其与病理学的关系

Echocardiographic characteristics and pathological findings of cardiac metastatic tumors

目的 :探讨心脏转移性肿瘤的超声心动图特征及其与病理学改变的关系。方法 :回顾性分析 2 4 5例心脏转移性肿瘤患者的超声心动图学改变和病理学特征等资料。结果 :①鳞状细胞癌、腺癌和淋巴瘤是转移到心脏的最常见肿瘤 ,三者占全部心脏转移性肿瘤的 74 .3% (182 / 2 4 5 ) ;②经胸超声心动图检查结果显示 2 2 6例(92 .2 % )有心包渗出、增厚或心脏肿物等异常表现 ,仅 19例 (7.8% )未发现有诊断意义的变化 ;其中有 5 5 .5 %的患者 (12 5 / 2 4 5 )肿瘤累及心包 ,同时发现 2个或 2个以上肿物者占 2 1.2 % (48/ 2 4 5 ) ;③右侧心脏转移性肿瘤明显多于左侧心脏 [36 .7% (83/ 2 2 6 )∶10 .6 % (2 4 / 2 2 6 ) ,P <0 .0 5 ],肿瘤同时累及右房和下腔静脉者明显多于同时累及右房和右室者 (5 .8%∶0 .4 % ,P <0 .0 1) ;④虽然腺癌 (43/ 5 7,73.7% )和间皮瘤 (11/ 12 ,91.7% )转移至心包的比例较鳞状细胞癌 (44 / 96 ,37.5 % ;P <0 .0 1)为高 ,但这两种肿瘤很少同时转移至右房和右室 (P <0 .0 5 )。结论 :在心脏转移性肿瘤的诊断中 ,超声心动图是一种较敏感的检查手段 。

Objective:To investigate the relationship between echocardiographic characteristics and pathologic findings of cardiac metastatic tumors. Methods: The echocardiography and pathological data of 245 patients with cardiac metastatic tumors were analyzed retrospectively.Results: ① The histological distribution of 245 patients showed that carcinoma, adenocarcinoma and lymphoma were the common tumors metastasized to the heart (182 cases, 74.3 %) ② Transthoracic echocardiograms were available for all 245 patients. The pericardial effusion, thickening or cardiac masses were found in 226 ( 92.2 %) cases, and only 19 ( 7.8 %) cases did not present any diagnostic changes with echocardiography. There was pericardial abnormality in more than half patients ( 55.5 %, 125/245), while two or more masses were only found in 48 ( 21.2 %) cases.③The tumors in the right heart detected by echocardiography were significantly more than those in left heart (83/226, 36.7 % vs. 24/226, 10.6 %; P< 0.05 ), and the masses found simultaneously in right atrium and inferior vena cava were significantly higher than those in right atrium and right ventricle (1/226, 0.4 %, P< 0.01 ). ④ The pericardium was more often involved in the patients with adenocarcinoma (43/57, 73.7 %) and mesothelioma (11/12, 91.7 %) compared with carcinoma (44/96, 37.5 %, P< 0.01 ), but right atrium and ventricle were significantly less involved in the cases with adenocarcinoma and mesothelioma (P< 0.05 ). Conclusion: The echocardiography is a sensitive tool for cardiac metastatic tumors and may help to identify the pathological diagnosis.