Primary cardiac tumors are quite rare and most of these tumors are benign.In this report,a patient presented with chest distress and shortness of breath after activity.Echocardiography of other hospital showed a hyper...Primary cardiac tumors are quite rare and most of these tumors are benign.In this report,a patient presented with chest distress and shortness of breath after activity.Echocardiography of other hospital showed a hyperechoic right atrial mass.Electrocardiogram-gated cardiac computed tomography(ECG-Gated CT) of our hospital provided accurate information about the site and extent of the tumor,and the involvement of neighboring structures,even about the malignant nature of the lesion.The pathological study indicated angiosarcoma.The role of ECG-Gated CT in the assessment of cardiac masses and tumors was discussed.Cardiac tumors are extremely rare and can be divided into benign and malignant lesions.Myxomas are the most common type of cardiac benign tumor,while angiosarcomas are the most common type of cardiac malignant tumor.Imaging studies play an important role in the diagnosis of cardiac angiosarcomas.Echocardiogram,computed tomography(CT) and magnetic resonance imaging(MRI) are the most common imaging studies for tumors evaluation.However,the precise tumor location is often difficult to evaluate precisely on the basis of two-dimensional source images.We conducted ECG-gated cardiac CT examination with 3D reconstruction for preoperative assessment in a patient with a angiosarcoma arising in the right atrium.展开更多
文摘1病例资料患者男，37岁，因发热、胸闷伴胸背部酸胀10 d入院，有胸部隐痛、咳嗽、气喘、低热不退、盗汗、全身乏力等症状，无体质量减轻。查体：心音正常，各瓣膜区未闻及明显杂音，有心包摩擦音。门诊就诊时行急诊超声心动图检查发现少至中等量心包积液及右房实质性团块（考虑为赘生物或继发灶可能），以“心包积液”收入院，住院期间结合患者症状考虑结核性心包炎可能性大，在抗感染治疗基础上行抗结核药物诊断性治疗，并加用糖皮质激素防止心包粘连。欲行心包积液穿刺定位并心包积液生化及其他相关检查，但因心包积液主要集中于侧心包，穿刺难度较大，未能成功穿刺。后经强心利尿、抗生素、抗〈br〉 结核、糖皮质激素规范化治疗10 d后复查超声心动图发现心包腔未见明显积液，右心房顶部、上腔静脉入口处见实质性团块（图1、2），大小约33 mm ＆#215;24 mm，以宽基底附着于右房顶部，无蒂，反复观察未见明显移动征象，上腔静脉回流受压，局部血流轻度加速，考虑右房恶性肿瘤可能性大。后请心胸外科会诊因右房占位有手术指征转入心胸外科，因入院检查TB-Ab、PPD试验均为阴性，结核证据不足暂不予抗结核治疗，继续强心利尿、抗感染治疗。2012年12月6日患者在皖南医学院附属弋矶山医院心胸外科行全体外循环下右房肿瘤切除术，术中准备快速病理，明确肿瘤性质以便手术方案的选择。术中发现，心包有少量血性渗出液。完整切除肿瘤及右房壁，心包补片修补右房，切除肿瘤大小约45 mm ＆#215;30 mm，肉眼呈灰红、灰白色，呈“鱼肉样”，质偏韧。手术病理结果：血管肉瘤，瘤组织侵及心肌、神经，脉管内见瘤栓。免疫组化：CD34（＋）、CD31（＋）、F8部分（＋）、bcl-2（＋）、S-100蛋白（-），结果符合血管肉瘤并提示中低度恶性（图3）。
文摘Primary cardiac tumors are quite rare and most of these tumors are benign.In this report,a patient presented with chest distress and shortness of breath after activity.Echocardiography of other hospital showed a hyperechoic right atrial mass.Electrocardiogram-gated cardiac computed tomography(ECG-Gated CT) of our hospital provided accurate information about the site and extent of the tumor,and the involvement of neighboring structures,even about the malignant nature of the lesion.The pathological study indicated angiosarcoma.The role of ECG-Gated CT in the assessment of cardiac masses and tumors was discussed.Cardiac tumors are extremely rare and can be divided into benign and malignant lesions.Myxomas are the most common type of cardiac benign tumor,while angiosarcomas are the most common type of cardiac malignant tumor.Imaging studies play an important role in the diagnosis of cardiac angiosarcomas.Echocardiogram,computed tomography(CT) and magnetic resonance imaging(MRI) are the most common imaging studies for tumors evaluation.However,the precise tumor location is often difficult to evaluate precisely on the basis of two-dimensional source images.We conducted ECG-gated cardiac CT examination with 3D reconstruction for preoperative assessment in a patient with a angiosarcoma arising in the right atrium.
