以动脉栓塞为首发症状的心脏黏液瘤的临床病理特征

Clinicopathological characteristic of cardiac myxoma with arterial embolism as the first symptom

目的:探讨以动脉栓塞为首发症状的心脏黏液瘤患者的临床、病理特征及鉴别诊断。方法:7例经手术治疗证实以动脉栓塞为首发症状的心脏黏液瘤病例,回顾其临床资料,并对其临床表现、影像学特征及病理学改变进行分析。结果:①7例均因动脉栓塞症状就诊,其中肺动脉栓塞3例,腹主动脉及髂动脉栓塞2例,股总动脉栓塞1例,腘动脉及胫后动脉栓塞1例,经病理学检查证实为黏液瘤栓塞。②7例中男性5例,女性2例,平均年龄为(47. 57±10. 39)岁。③3例伴有肺动脉栓塞表现,2例有非特异性全身症状,1例只出现下肢动脉栓塞症状,无心内梗阻及非特异性全身表现,另1例无任何症状,系外伤后出现动脉栓塞症状入院。④超声心动图提示,左心房黏液瘤4例,右心房黏液瘤2例,右心室黏液瘤1例。结论:心脏黏液瘤引起的栓塞的临床表现,主要取决于栓塞部位,与血栓栓塞性疾病难以鉴别,常易导致误诊及漏诊,因此,遇到动脉栓塞的患者时要排除心脏黏液瘤引起的栓塞的可能,并充分结合影像学检查做出准确、及时的诊断。

Objective:To investigate the clinical and pathological features as well as differential diag-nosis of patients with cardiac myxoma diagnosed with arterial embolization as the first symptom.Methods:7 ca-ses of cardiac myxoma with arterial embolization as the first symptom were collected and all of them received surgical treatment,the clinical data were reviewed,and the clinical manifestations,imaging characteristics and pathological changes were analyzed.Results:①7 patients were diagnosed with arterial embolism,including 3 patients with pulmonary embolism,2 patients with abdominal aorta and iliac arteries embolism,1 with femoral artery embolism,and 1 with popliteal and posterior tibial arteries embolism.The pathological examination con-firmed myxoma embolus.②Among the 7 patients,5 were male and 2 were female,with an average age of(47.57±10.39)years old.③3 patients showed clinical manifestations of pulmonary embolism,2 patients had constitutional symptoms,and 1 patient had only lower extremity arterial embolism symptoms.1 patient had no symptoms and was admitted to hospital due to arterial embolism after trauma.④Echocardiography suggested that there were 4 cases of left atrial myxoma,2 cases of right atrial myxoma,and 1 case of right ventricular myxoma.Conclusions:The clinical manifestations of embolism caused by cardiac myxoma are not specific,mainly de-pending on the embolization site,and it is difficult to identify with thromboembolic disease,which often leads to misdiagnosis and missed diagnosis.Therefore,when patients with arterial embolism are encountered,it is hoped that clinicians can exclude the possibility of embolism caused by cardiac myxoma,and make accurate and timely diagnosis based on imaging examnation.