产前超声检查胎儿完全型肺静脉异位引流的漏诊及误诊病例分析

Analysis of Missed Diagnosis and Misdiagnosis of Fetal Total Anomalous Pulmonary Venous Connection using Prenatal Ultrasound

目的:探讨产前超声诊断胎儿完全型肺静脉异位引流(TAPVC)的漏诊及误诊的原因。方法:回顾性分析24例经超声心动图检查确诊为TAPVC胎儿的资料,统计漏诊及误诊数,并对原因进行分析。结果:经超声心动图检查确诊的24例完全型肺静脉异位引流胎儿中,心上型11例,心内型9例,心下型4例。其中经产前超声确诊13例,漏诊7例(2例心上型、4例心内型、1例心下型),误诊4例(3例心上型、1例心下型)。漏诊病例多由于合并其它心脏结构异常,导致心房后区域结构显示不清,误诊病例均诊断为部分型肺静脉异位引流,多由于检查时出现肺静脉的引流途径不一致的假象。结论:对正常肺静脉及左心房后区域认识不足,是导致肺静脉异位引流经常漏诊及误诊的主要原因。

Objective: To explore the reasons for missed diagnosis and misdiagnosis of fetal complete pulmonary vein ectopic drainage diagnosed by prenatal ultrasound. Methods: 24 patients with complete pulmonary vein ectopic drainage confirmed by echocardiography were selected as the research objects. Retrospective analysis of prenatal ultrasound in pregnant women was conducted to count the number of missed diagnosis and misdiagnosis and analyze the causes. Results: Among 24 cases of total anomalous pulmonary venous connection confirmed by echocardiography, 11 cases were of supracardiac type, 9 cases of endocardial type and 4 cases of subcardiac type. Among them, 13 cases were diagnosed by prenatal ultrasound, 7 cases were missed(2 cases of supracardiac type, 4 cases of endocardial type, 1 case of subcardiac type), 4 cases were misdiagnosed(3 cases of supracardiac type, 1 case of subcardiac type). Most of the missed cases were complicated with other cardiac structural abnormalities, which led to unclear regional structure of the posterior atrium. All the misdiagnosed cases were diagnosed as partial anomalous pulmonary venous drainage, mostly due to the false appearance that the drainage pathway of pulmonary vein was inconsistent during the examination. Conclusion: The main reason for misdiagnosis and missed diagnosis of anomalous pulmonary vein connection is the lack of recognition of normal pulmonary vein and left atrial posterior area.