经胸心脏超声检查诊断原发性前上纵膈滑膜肉瘤的临床分析

Clinical analysis of primary anterior superior mediastinal synovial sarcoma diagnosed by transthoracic echocardiography

目的:分析前上纵隔滑膜肉瘤(anterior mediastinal synovial sarcoma,AMSS)的声像图表现特点,探讨超声对其诊断、治疗及术后随访的价值。方法:2019年11月,我院用Philips EPIQ7C心脏专用机S5-1探头,诊断1例AMSS病例,分析其各阶段的临床表现、病理学特征、超声及其他影像学表现。结果:心脏彩超提示:1.右房后上方实质性占位性病变(7.6 cm×5.9 cm的低回声肿块,并致使右房受压,界限清,形态规则,内部回声均匀,观察其内可见星点状血流信号);2.右房内囊性占位,粘液瘤?3.左室假腱索。术后给予化疗,术后4个月复查胸部CT、超声未见明显异常,未发生心脏、肺及胸膜的转移。结论:原发性AMSS是一种罕见的侵袭性恶性肿瘤,超声以心脏作为透声窗可以较清楚显示滑膜肉瘤(synovial sarcoma,SS)的深度、大小、边界、内部回声等二维特征及血流情况,并可监测肿瘤的复发情况。

Objective To study the ultrasonographic features of anterior superior mediastinal synovial sarcoma,and to explore the value of ultrasound in its diagnosis,treatment and postoperative follow-up.Methods In November 2019,a case of AMSS was diagnosed by Philips EPIQ7C cardiac machine S5-1 probe in our hospital,and the clinical manifestations,pathological features,ultrasound and other imaging manifestations at various stages were analyzed.Results Color doppler echocardiography indicated:1.A substantial space-occupying lesion(a low-echoic mass of 7.6cm×5.9cm in the posterior upper right atrium,which caused the compression of the right atrium,with clear boundary,regular shape,uniform internal echo,and star-dotted red and blue blood flow signals in color observation),whose nature was to be determined;2.Cystic space occupation in the right atrium,myxoma?3.Left ventricular pseudochordae tendineae.4 months after surgery,chest CT and ultrasound showed no obvious abnormalities,and no metastasis of heart,lung and pleura occurred.Conclusion Primary anterior superior mediastinal synovial sarcoma is a rare invasive malignant tumor.Ultrasound using the heart as a sound window can clearly display the depth,size,boundary,internal echo and other two-dimensional characteristics of synovial sarcoma and blood flow,and can monitor the recurrence of tumor.