Tang Kui, Shang Quan-Liang, Zhou Qi-Chang, Zhou Jia-Wei, She Xiao-Lin, Zhang Ming
Department of Ultrasound, the 2nd Xiangya Hospital of Central South University, Hunan, China.
Echocardiography. 2013 Jul;30(6):E156-60. doi: 10.1111/echo.12176. Epub 2013 Mar 12.
Primary tumors of the heart are rarely seen. Cardiac angiosarcomas are malignant tumors that almost always have a poor prognosis. Atrium rupture and coronary artery fistula are very rare complications of primary cardiac angiosarcoma. We describe a 57-year-old man suffering from primary cardiac angiosarcoma with spontaneous ruptures of the right atrium and right coronary artery (RCA). Theoretically, either of these ruptures invariably results in pericardial effusion and tamponade that is rare but potentially life threatening. In this instance, however, the patient might have developed fibrous adhesions resulted from previous bloody pericardial effusion. A massive pericardial effusion was localized, which consequently prevented cardiac tamponade and hemodynamic collapse. Echocardiography revealed the tumor progression leading to detectable infiltration of solid mass into the right atrial (RA) wall, which is close to RCA. And color Doppler displayed the flow into the pericardial cavity through a disrupted RA wall and perforated RCA. Echocardiography remains the primary method of choice for evaluation of cardiac masses.
原发性心脏肿瘤很少见。心脏血管肉瘤是恶性肿瘤，其预后几乎总是很差。心房破裂和冠状动脉瘘是原发性心脏血管肉瘤非常罕见的并发症。我们描述了一名57岁男性，患有原发性心脏血管肉瘤，伴有右心房和右冠状动脉（RCA）的自发性破裂。理论上，这些破裂中的任何一种都必然导致心包积液和心包填塞，这虽然罕见但可能危及生命。然而，在这种情况下，患者可能因先前的血性心包积液而形成了纤维粘连。大量心包积液被局限化，从而防止了心包填塞和血流动力学崩溃。超声心动图显示肿瘤进展，导致可检测到实性肿块浸润到靠近RCA的右心房（RA）壁。彩色多普勒显示血流通过破裂的RA壁和穿孔的RCA进入心包腔。超声心动图仍然是评估心脏肿块的主要首选方法。
