异位引流入上腔静脉的心上型肺静脉异位引流的超声诊断漏诊和误诊原因分析

The value of ultrasound diagnosis of supracardiac pulmonary venous ectopic drainage into the superior vena cava

目的:探讨超声心动图诊断异位引流入上腔静脉的心上型肺静脉异位引流(SAPVC)的漏诊和误诊原因。方法:回顾分析19例均经CT和(或)手术证实且矫治成功的SAPVC异位引流入上腔静脉的超声心动图特征,评估术前和术后上腔静脉内径、血流速度、汇入位置及合并畸形,分析其诊断准确率及漏诊和误诊率。结果:19例SAPVC(14例部分型、3例完全型和2例混合型)的异位肺静脉开口于上腔静脉,超声确诊9例(47.37%)、漏诊7例(36.84%)、误诊3例(15.78%)。肺静脉变异支数共13例(12例5支、1例7支),其变异率为68.42%,且汇入上腔静脉的部位多见近心段。16例合并简单先天性心脏病,3例合并主动脉缩窄、永存左上腔、二叶式主动脉瓣等心内畸形。结论:经胸超声心动图容易漏诊或误诊异位引流入上腔静脉的SAPVC。全面扫查胸骨旁、剑突下及胸骨上窝上腔静脉长轴观察有无异常静脉血流汇入上腔静脉,加强伪像、正常或异常心内结构鉴别及联合CT可降低漏、误诊率。

Objective: To explore the reasons for the missed diagnosis and misdiagnosis of supracardiac anomalous pulmonary venous connection(SAPVC) ectopic to the superior vena cava by echocardiography. Methods: This was a retrospective analysis that was the echocardiographic characteristics of 19 cases of SAPVC ectopic to the superior vena cava confirmed and successfully corrected by CT and(or) surgery. To evaluate the internal diameter, blood flow velocity, confluence position, and combined malformations of the superior vena cava before and after surgery, and analyzed its diagnostic accuracy, missed and misdiagnosed rates. Results: In 19 cases(14 cases of partial type, 3 cases of complete type and 2 cases of mixed type) of SAPVC, the ectopic pulmonary veins opened in the superior vena cava. Ultrasound confirmed 9 cases(47.37%), missed diagnosis in 7 cases(36.84%), and misdiagnosed in 3 cases(15.78%). There were 13 cases of variant pulmonary veins(5 pulmonary veins in 12 cases, 7 pulmonary veins in 1 case), the variation rate was 68.42%, and the proximal vena cava was more common in the proximal heart segment. Sixteen cases had simple congenital heart disease, and 3 cases had intracardiac malformations such as coarctation of the aorta, permanent left upper lumen, and two-leaflet aortic valve. Conclusion: Transthoracic echocardiography was easy to miss or misdiagnose SAPVC ectopic into the superior vena cava. Comprehensive scanning of the parasternal, subxiphoid and superior sternal fossa superior vena cava long axis to observe whether there was abnormal venous blood flow into the superior vena cava, strengthen the false image, the identification of normal or abnormal intracardiac structures and combined with CT could reduce the missed misdiagnosis rate.