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右心房黏液瘤导致的肺栓塞。

Pulmonary embolism due to the right atrial myxoma.

作者信息

Fabijanić Damir, Rudez Igor, Kardum Dusko, Radić Mislav, Glavas Duska, Lozo Petar

机构信息

Department of Medicine, University Hospital Split, Split, Croatia.

出版信息

Coll Antropol. 2006 Dec;30(4):933-6.

Abstract

A 47-year-old man was admitted to the hospital with a pleuritic pain, dyspnea, nonproductive cough and low-grade fever. An ECG documented a sinus tachycardia with S1Q3T3 pattern and incomplete right bundle branch block, and lung scintigraphy showed multiple perfusion defects. The initial diagnosis was pulmonary embolism. Echocardiography, undertaken before application of the anticoagulant therapy because of hematological disturbances reflecting possible coagulopathy (elevated erythrocyte sedimentation rate, increased leukocyte count, decreased platelet count), revealed a large mobile tumor in the right atrium. Tumor was surgically removed, and histological findings was supported a diagnosis of the cardiac myxoma. The right cardiac myxoma should be considered in the differential diagnosis of pulmonary embolism, particularly in cases presented in conjunction with constitutional symptoms and/or hematological disturbances. In these patients echocardiography should be undertaken early to exclude the rare but treatable diseases of the right heart.

摘要

一名47岁男性因胸膜炎性胸痛、呼吸困难、干咳和低热入院。心电图显示窦性心动过速伴S1Q3T3模式及不完全性右束支传导阻滞,肺部闪烁扫描显示多处灌注缺损。初步诊断为肺栓塞。由于存在反映可能凝血功能障碍的血液学异常(红细胞沉降率升高、白细胞计数增加、血小板计数减少),在应用抗凝治疗前进行了超声心动图检查,结果显示右心房有一个大的活动肿瘤。肿瘤经手术切除,组织学检查结果支持心脏黏液瘤的诊断。在肺栓塞的鉴别诊断中应考虑右心黏液瘤,尤其是伴有全身症状和/或血液学异常的病例。对于这些患者,应尽早进行超声心动图检查以排除罕见但可治疗的右心疾病。

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