Department of Radiology, University of Texas Health Science Center, San Antonio, Tex.
Radiographics. 2013 Oct;33(6):1613-30. doi: 10.1148/rg.336135512.
Primary pericardial tumors are rare and may be classified as benign or malignant. The most common benign lesions are pericardial cysts and lipomas. Mesothelioma is the most common primary malignant pericardial neoplasm. Other malignant tumors include a wide variety of sarcomas, lymphoma, and primitive neuroectodermal tumor. When present, signs and symptoms are generally nonspecific. Patients often present with dyspnea, chest pain, palpitations, fever, or weight loss. Although the imaging approach usually begins with plain radiography of the chest or transthoracic echocardiography, the value of these imaging modalities is limited. Cross-sectional imaging, on the other hand, plays a key role in the evaluation of these lesions. Computed tomography and magnetic resonance imaging allow further characterization and may, in some cases, provide diagnostic findings. Furthermore, the importance of cross-sectional imaging lies in assessing the exact location of the tumor in relation to neighboring structures. Both benign and malignant tumors may result in compression of vital mediastinal structures. Malignant lesions may also directly invade structures, such as the myocardium and great vessels, and result in metastatic disease. Imaging plays an important role in the detection, characterization, and staging of pericardial tumors; in their treatment planning; and in the posttreatment follow-up of affected patients. The prognosis of patients with benign tumors is good, even in the few cases in which surgical intervention is required. On the other hand, the length of survival for patients with malignant pericardial tumors is, in the majority of cases, dismal.
原发性心包肿瘤罕见，可分为良性或恶性。最常见的良性病变为心包囊肿和脂肪瘤。间皮瘤是最常见的原发性恶性心包肿瘤。其他恶性肿瘤包括各种肉瘤、淋巴瘤和原始神经外胚层肿瘤。当出现时，体征和症状通常无特异性。患者常表现为呼吸困难、胸痛、心悸、发热或体重减轻。虽然影像学方法通常始于胸部平片或经胸超声心动图，但这些影像学方式的价值有限。另一方面，横断面成像在这些病变的评估中起着关键作用。计算机断层扫描和磁共振成像可以进一步进行特征描述，并且在某些情况下可以提供诊断结果。此外，横断面成像的重要性在于评估肿瘤与邻近结构的确切位置。良性和恶性肿瘤都可能导致重要纵隔结构受压。恶性病变也可能直接侵犯心肌和大血管等结构，并导致转移性疾病。影像学在心包肿瘤的检测、特征描述和分期、治疗计划以及受影响患者的治疗后随访中起着重要作用。良性肿瘤患者的预后良好，即使在需要手术干预的少数情况下也是如此。另一方面，大多数情况下，恶性心包肿瘤患者的生存时间都不容乐观。
