19例原发性肝癌心脏转移患者超声特征表现和预后分析

Ultrasonographic feature and prognosis of patients with hepatocellular carcinaoma and cardiac metastases:Analysis of 19 cases

目的总结肝细胞癌(HCC)心脏转移的超声表现特征,并分析其预后。方法2013年1月~2019年5月我院收治的19例HCC心脏转移患者,回顾分析患者心脏超声表现,总结其特征,并随访其预后。结果16例(84%)在肝癌相邻的肝静脉内可见实性回声,并延续至下腔静脉和右心房,3例(16%)肝癌相邻下腔静脉内可见实性回声,并延续至右心房;13例(68%)为混合回声,6例(32%)为低回声;15例(79%)边界清晰,16例(84%)形态不规则;19例(100%)右心房癌栓内未见血流信号;12例(63%)右心房癌栓随心动周期活动,活动规律与心动周期无关,7例(37%)右心房癌栓随心动周期活动不明显;3例(16%)累及右室流入道;本组患者发现右心房肿瘤转移后生存时间为25~412天,其中2例患者出现急性肺栓塞。结论肝静脉-下腔静脉-右心房或下腔静脉-右心房连续性癌栓是本病最重要的超声表现,本病患者生存时间短,可并发急性肺栓塞而死亡。

Objective The ultrasonographic feature and prognosis of patients with hepatocellular carcinoma(HCC)and cardiac metastasis were summarized.Methods A total of 19 patients with HCC and cardiac metastasis were admitted to our hospital between January 2013 and May 2019,and all patients underwent ultrasonography and followed-up for 12 months.The diagnosis was confirmed by histopathological examination.Results The solid echo was observed in adjacent hepatic veins and extended to inferior vena cava and right atrium in 16 cases(84%),the solid echogenicity was observed in adjacent inferior vena cava and extended to right atrium in 3 cases(16%),the mixed echo was found in 13 cases(68%)and the hypoechoic in 6 cases(32%);the clear boundaries was found in 15 cases(79%)and the irregular morphology was found in 16 cases(89%);there was no blood flow signal of tumor thrombus in the right atrial in 19 cases(100%);no relationship with cardiac cycle was found in 12 cases 63%,and no significant relationship with cardiac cycle was found in 7 cases(37%);the right ventricular inflow tract was involved in 3 cases(16%);the survival time after right atrial metastasis was found was 25 to 412 days,and acute pulmonary embolism was found in 2 patients.Conclusion The continuous cancerous thrombus extending from hepatic vena to inferior vena cava to right atrium or to inferior vena cava to right atrium is the most important ultrasonographic manifestations in patients with HCC and cardiac metastasis.The patients at this circumstance have a very short survival time and might have acute pulmonary embolism at any time.