结核性缩窄性心包炎多参数心脏磁共振表现1例报道

A case of Tuberculous constrictive pericarditis—evaluation with multi-parameter cardiac magnetic resonance

缩窄性心包炎是由急性或者慢性心包炎迁延不愈导致,结核是其主要致病菌。影像学多表现为心包膜增厚粘连、纤维化,伴或不伴钙化,临床上,通过病史及影像学诊断并不困难。诊断要点主要为结核病史、结核性浆膜腔积液、结核实验室检查、心包缩窄的临床表现及心包增厚粘连缩窄纤维带等影像学表现,尤其是影像学检查提示明确的心包增厚或钙化即需考虑缩窄性心包炎。本例患者临床及影像特征均不明显,心包膜始终没有出现典型粘连及钙化征象,早期诊断缩窄性心包炎极具挑战性。因此,联合多模态心脏磁共振检查,在明确心肌改变的同时,可以对缩窄性心包炎引起的心脏结构、功能、运动异常作综合定量评估,为疾病的早期诊断提供更多的影像学证据进而降低漏诊率。

Constrictive pericarditis is caused by acute or chronic pericarditis in delayed healing and the tuberculosis(TB)is the main pathogenic bacteria.Pericardial thickening adhesions,fibrosis,with or without calcification are the most common imaging performance.Clinically,it is not difficult to make diagnosis through medical history and imaging.The main points of diagnosis are tuberculosis history,tuberculous serous effusion,tuberculous experimental examination,pericardium constriction,pericardium thickening and adhesion to constricted fibrous bands.Especially the imaging presentation with pericardial thickening or calcification is typical sign of diagnosis of the disease.The clinical and imaging feature in this case are not obviously that the pericardium did not show the typical signs of adhesion and calcification.Therefore,early diagnosis of constrictive pericarditis is extremely challenging.The combination of multimodality cardiac magnetic resonance examination can not only clarify the pericardium condition and cardiac changes,but also make a comprehensive quantitative assessment of cardiac structure,function and movement abnormalities caused by constrictive pericarditis,so as to provide more imaging evidence for early diagnosis of the disease and further to reduce misdiagnosis rate.